Oral
Answers to
Questions

INTERNATIONAL DEVELOPMENT

The Secretary of State was asked—

Violence against Women and Girls

John Pugh: What steps she is taking to support grassroots women’s rights organisations which are working to tackle violence against women and girls in developing countries.

Priti Patel: It is an honour to stand here today as the International Development Secretary. I believe passionately in my Department’s mission to end extreme poverty. Violence against women and girls is a global scandal that the Department for International Development is working to end. We invest in hundreds of organisations to improve the lives of millions of women and girls globally. I pay tribute to the leadership of my predecessor, my right hon. Friend the Member for Putney (Justine Greening) on the issue. I am determined to continue our work on this agenda.

John Pugh: Only 1% of gender-specific funds are spent on women’s rights organisations. Does the Secretary of State not think she could do more, and will she align with ActionAid, whose campaign “Fearless” has really taken off?

Priti Patel: I pay tribute to those involved in championing that campaign. There are more than 40 existing mechanisms through which funding is channelled to women’s rights organisations. I believe—rightly so—that we channel our funding in the right way to support the right objectives and outcomes for women and girls around the world.

Caroline Spelman: I warmly welcome my right hon. Friend to her place. Women refugees often suffer violence on their journeys to safety, and the practice of registering only the head of the family in asylum processes often leaves their needs neglected. Will the Secretary of State reassure the House that at the UN summit on refugees next week the voice of women refugees will get a proper hearing?

Priti Patel: I thank my right hon. Friend for her very important and significant question. She is right to point out that there is a conference at the UN General Assembly next week specifically on refugees, on which our Prime Minister and President Obama will be leading. Those  are the very issues and challenges that will be reflected in the summit, and Britain will lead the way in standing up for the rights of women refugees and doing the responsible thing for them.

Carol Monaghan: During the summer holidays many girls are taken from the UK to developing countries, where they are subjected to the brutality of female genital mutilation. What is the Secretary of State doing to prevent those girls from being taken out of the country in that way?

Priti Patel: The hon. Lady rightly highlights the abhorrent practice of FGM and that vulnerable girls are abused in that way. I am working with colleagues across Government on a strategy to ensure not just that we do more but that we end that practice and, importantly, bring the perpetrators of that abhorrent crime to justice.

Hannah Bardell: An Independent Commission for Aid Impact report says that support for women’s rights organisations remains

Priti Patel: As I said in my opening remarks, I pay tribute to the work of my predecessor, who has led the way on women’s rights and rights for girls. The hon. Lady is right to point to the SDGs. DFID is doing a great deal. We recognise the critical role of women’s rights and the organisations that we partner and work with. We will continue to do exactly that.

Christina Rees: I welcome the Secretary of State to her place. What programmes does her Department provide to counter the use of rape and sexual violence as a weapon of war and subjugation?

Priti Patel: The hon. Lady raises the abuse and the abhorrent crimes that take place against women and girls in conflict and conflict zones. We work with a whole range of organisations, and civil society also plays a part in achieving the right outcomes. We work with Governments around the world and through our multilateral relationships through the United Nations not only to work with countries and organisations to try to stop that practice but to deal with the perpetrators of those appalling crimes.

Syria: Aid

Kerry McCarthy: What aid her Department is providing to civilians in (a) Aleppo and (b) other besieged areas in Syria.

Priti Patel: My Department has funded the United Nations and non-governmental organisations to provide food, water, healthcare and nutritional supplies to Aleppo. We have allocated £561 million to support vulnerable people inside Syria, including in Aleppo and other besieged areas, where access is possible.

Kerry McCarthy: I thank the Secretary of State for that response but, despite the ceasefire this week, we are hearing from the UN special envoys that the Syrian regime is continuing to restrict aid to eastern Aleppo. We have also heard reports that two barrels of chlorine gas were dropped by helicopter on civilian neighbourhoods, injuring many people including children. What will the Secretary of State do to facilitate access for humanitarian aid?

Priti Patel: The hon. Lady is absolutely right. The Syria crisis is appalling in every single aspect we see and experience. The point about aid is significant because we have had significant access problems. The ceasefire has just come into being and, obviously, we are working with the UN and our partners to look at getting much needed aid and supplies into the besieged areas, which have not seen aid for a considerable time. All colleagues in the House recognise this, but it is worth pointing out again that this is an appalling crisis and conflict. On the perpetrator—Assad—we are working on the wider conflict resolution, but our priority is to ensure that we can get humanitarian supplies in.

Damian Collins: Will the Secretary of State give the House an update on the progress that has been made on raising funds to support humanitarian aid in Syria since the London Syria conference earlier this year?

Priti Patel: The UK led the way with the Syria conference. We have pledged more than £2.3 billion in response to the humanitarian crisis in Syria and the region. We have the UN General Assembly next week, where we will again make the case for the donors to do more to raise more money, and for greater partnership working, to alleviate many of the hardships that we see in the crisis in Syria.

Tasmina Ahmed-Sheikh: All hon. Members hope that the ceasefire will mean safer passage for the convoys to reach the besieged cities. What discussions is the Secretary of State having with the Foreign and Commonwealth Office and Ministry of Defence on potential airdrops, if deemed necessary, to ensure that support gets to those who need it so desperately?

Priti Patel: The hon. Lady recognises and reflects upon the severity of the situation. I am working with colleagues in both Departments she mentioned. Obviously, the ceasefire has only just come into being. We are looking at all avenues to get humanitarian and support in, and at how we can help the affected populations. Delivering aid by road by our trusted partners ensures that it gets to the most vulnerable. Airdrops come with a greater risk but, as I have said, with the ceasefire coming into fruition at the beginning of the week, we are looking at all avenues for aid delivery.

Neil Carmichael: What discussions is the Secretary of State having with our partners and allies on this matter, especially in connection with action to provide good support for children and families in Syria?

Priti Patel: My hon. Friend makes a very important point. I am speaking to all our partners—global donors, global partners and other Governments—importantly   recognising that humanitarian aid is essential, as is protecting and safeguarding vulnerable people. That is part of our ongoing work with multilateral organisations, and an ongoing area of our work in the Government.

Kate Osamor: I welcome the Secretary of State to her place. To be clear, about 300,000 people are believed to be in east Aleppo; civilians are trapped inside the city’s eastern neighbourhoods and are experiencing bombing; and children have been left crippled and dead. This is a humanitarian crisis and we need to work together to ensure there is help where help is needed. Many questions have been asked today. I thank the House, because we are standing together, but will the Secretary of State elaborate on what mechanisms are in place at this point in time and what mechanisms she will explore?

Priti Patel: I thank the hon. Lady for her welcome and look forward to working with her on many such global challenges and crises. She is right to highlight the extent of humanitarian suffering in Aleppo we are comprehending. I was in Brussels on Monday meeting my development counterparts, and I speak on a near-daily basis to my opposite numbers around the world. The focus for us is the humanitarian crisis, and on getting aid into the besieged areas, and to the people who desperately need aid but who have not been receiving it. I will continue the work we are undertaking and continue to update the House.

Nepal Earthquake: Aid

Yasmin Qureshi: What support her Department has provided to victims of the earthquake in Dolakha, Nepal of May 2015.

Rory Stewart: On behalf of the Department, I express our great condolences on the impact of the earthquake. Some 700,000 people lost their homes and 9,000 people were killed. Specifically in relation to Dolakha, we have provided a great deal of support, including housing grants for 40,000 houses, and cooking equipment, blankets and tarpaulins for 7,000 people.

Yasmin Qureshi: I warmly welcome the Minister to his place. A Must for Dolakha is a charity based in Farnworth in my constituency. Mr Heslop, who represents the charity, visited the region recently and found that a number of people did not have any food or shelter. There was a feeling that aid had not reached a number of people in need. Will the Minister meet me and representatives of the charity to discuss how we can best help the people affected in those areas?

Rory Stewart: I pay tribute to the hon. Lady and to her constituent for the work he does. We need to understand the scale of this catastrophe. DFID is spending £100 million this year. Even so, with 700,000 people having lost their homes, the situation is extremely challenging. The response in Dolakha is led by USAID and the World Bank. I am very happy to sit down with the hon. Lady and her constituent to discuss our forthcoming work on roads, police stations and health clinics in Dolakha itself.

Aid Budget

Scott Mann: What steps her Department is taking to ensure that its funding goes to legitimate causes.

James Wharton: DFID is engaged in tackling some of the great global challenges of our time. The Department has in place rigorous systems and processes to ensure that the money we spend gets to those for whom it is intended.

Scott Mann: Does the Minister agree that UK taxpayers need to be considered at every single step of the way when it comes to our aid spending?

James Wharton: I absolutely agree with my hon. Friend. He is absolutely right. He may have seen the words of my right hon. Friend the Secretary of State in the Daily Mail only today setting out her vision for the future direction of the Department’s spending. We need rigorous accountability. We need proper business cases. We need a clear sense of what we want to achieve. That is exactly what this ministerial team will bring and what this Government will deliver.

Catherine McKinnell: The Global Fund to Fight AIDS, Tuberculosis and Malaria is on track to save 22 million lives by the end of 2016. Can the Secretary of State confirm whether the UK will pledge the £1.2 billion called for at the Replenishment conference? How will she ensure that Britain’s contribution will retain its value in light of the pound’s post-Brexit fall against the dollar?

James Wharton: The UK has been a key contributor to the global health fund, which has made a real difference. I met only yesterday the chairs of the all-party groups on HIV/AIDS, tuberculosis and malaria to discuss the contribution the UK intends to make. My right hon. Friend the Secretary of State will be making an announcement in Montreal in the coming days to set out just what the UK will be doing.

Dominic Raab: I welcome the Secretary of State’s refreshing approach. May I urge her and her ministerial colleagues to revise the criteria for bilateral aid, so that countries refusing point-blank to accept foreign national offenders deported from the UK do not receive millions of pounds of taxpayers’ money?

James Wharton: As always, my hon. Friend has an eye for value for money in the interests of the British taxpayer. We are, of course, looking at what DFID does. DFID delivers a huge amount of difference: it changes lives and helps people across the globe. We want to ensure that every penny we spend is spent wisely. The comments he makes are very important, as part of that debate and discussion.

Nigel Dodds: There are grave concerns about the Palestinian Authority continuing to pay reward payments to convicted terrorists and the possible misappropriation of international aid from the  UK to the Palestinian Authority. Will the Minister look carefully at that once again in light of the grave concerns that are being expressed?

James Wharton: It is vital that the money that UK taxpayers spend on aid is spent on the right things and the right priorities. Where concerns are raised, they will of course be looked into in detail. If there are issues found to be arising, they will be addressed and tackled. The UK also believes in its commitment to helping the poorest in the world. Every penny spent on the purposes for which it is intended is a penny well spent. Any penny that goes missing is a life that may go unsaved.

Aid Budget: Value for Money

Edward Argar: What steps her Department is taking to ensure value for money in its aid budget.

Priti Patel: My predecessors in Government have made huge progress in improving British aid by creating an independent aid watchdog, introducing much tougher value-for-money controls and making DFID’s spending even more transparent.

Edward Argar: Can my right hon. Friend reassure me that in seeking value for money she will also ensure that British companies and organisations are able to tender competitively for all DFID contracts at home and abroad, and are not in any way disadvantaged when bidding against overseas companies?

Priti Patel: My hon. Friend makes a very important point. He will know of, and be familiar with, the regulations on procurement, but I want to assure him and the House that British firms and British small and medium-sized enterprises win a significant proportion of our work. In the last financial year, 74% of our supplier spend was with UK firms.

Stephen Doughty: The Secretary of State has clearly been very busy briefing The Mail on Sunday, along with her anti-aid special adviser. She mentioned transparency, so can she explain why funding for South Sudan, an area of great interest not only to our security forces but to our development needs, is to receive a cut in its budget next year from her Department? Will she continue to fund crucial humanitarian causes such as that one?

Priti Patel: I hope, Mr Speaker, that the hon. Gentleman heard my words earlier about the tremendous work of our Department when it comes to humanitarian aid, support and saving lives. The hon. Gentleman is absolutely right: we will continue to champion those individuals whose lives need saving where support is required in many countries around the world. That includes a lot of the institutional reform and the support that we bring.

John Bercow: I always hear the Secretary of State’s words. I have been hearing them for at least 20 years.

Eric Pickles: I welcome my right hon. Friend to the Dispatch Box and assure her that I, too, enjoyed reading the Daily Mail  this morning. As part of getting proper value, would it not make sense to reward those organisations that are working for peace within the middle east rather than to have money going to those who seek to encourage terrorism?

Priti Patel: My right hon. Friend raises important points. As I have said a number of times today, DFID is focused on value for money, but as he has rightly pointed out, we will work with organisations in the right way to make sure that we are delivering the right outcomes that meet our Government priorities—both peace and stability, as well as humanitarian causes.

Imran Hussain: I, too, would like to welcome the Secretary of State and her Ministers to their places, but in doing I wish to remind her of her predecessor’s commitment to transparency and scrutiny of the development budget to ensure value for money. Why, then, with the replenishment of the global health fund, which should be one of biggest multilateral commitments, just days away, have we not seen the publication of the multilateral and bilateral reviews?

Priti Patel: If I may repeat again, we are very focused, and my predecessors quite rightly worked hard and assiduously on value for money and greater transparency. I want to go even further by making the entire global aid system more transparent, more focused on results and more accountable to those we are trying to help. The hon. Gentleman rightly points to the global fund replenishment. A conference is taking place this weekend, and I will be making an announcement over the course of it. I shall also be making sure with that replenishment that we push the agenda of greater transparency and value for money.

Aid Budget: Government Departments

Chris Matheson: What proportion of the 0.7% of GDP allocated to international aid is planned to be spent by other Government Departments in 2016-2017.

Priti Patel: We will honour our commitment to the 0.7%. Based on the spending review settlement of 2015, other Government Departments will spend 14% of UK official development assistance in this financial year, including 4% spent through cross-government departmental funds such as the Conflict Stability and Security Fund and the prosperity fund.

Chris Matheson: Did the international aid transparency initiative not establish that the Ministry of Defence and the Foreign Office are “poor” and “very poor” at dispensing aid? Should not all of the 0.7% therefore be distributed through DFID?

Priti Patel: We have a cross-government strategy on how to spend ODA money on Government priorities. We want to address the challenges across the world—there are obviously many global threats—which is why the MOD and other Government Departments have oversight and spend in this area. I am leading, but I work with my colleagues across Government to ensure that the money is spent in the right way on those strategic priorities.

Wendy Morton: I welcome the new Secretary of State and her Ministers to their new roles. As a member of the International Development Select Committee, I look forward to seeing them in that Committee. Can she reassure me that the non-DFID ODA will continue to see the same amount of scrutiny as the DFID ODA?

Priti Patel: I thank my hon. Friend. She is absolutely right. We have the watchdog, the Independent Commission for Aid Impact. As the lead Government Department, leading on overspend, we ensure that the money going across Government Departments through this cross-government strategy is spent on the right priorities. It will be spent in the right way.

Patrick Grady: I welcome both the Government and the Opposition spokespersons to their posts. Will the Secretary of State confirm that, contrary to what the Defence Secretary told the “Today” programme, it does matter what budget conflict and security spending comes from? Will she guarantee that the Ministry of Defence will not raid the DFID budget, which should be spent on helping the poorest people around the world?

Priti Patel: As the world is changing, so must our approach to aid. That is why we have a cross-Government strategy to ensure that official development assistance meets Government priorities while also recognising and tackling the global challenges that we face. DFID will continue to be a leader when it comes to accountability and transparency, and that will, of course, apply to my colleagues throughout the Government as well.

John Bercow: Order. These are extremely important matters affecting some of the most vulnerable people on the face of the planet. They really do deserve—[Interruption.] Order. They really do deserve a more attentive audience. It would show some respect to very vulnerable people if we listened to the questions and to Ministers’ answers.

Kate Osamor: It was reported in The Guardian today that the Secretary of State has plans for a drastic overhaul in the direction of foreign aid, which will be based on “core Tory values”. Can she explain to us what the overhaul will look like, and how it will affect the most vulnerable?

Priti Patel: As I have already said today, my Department will be a champion of British taxpayers when it comes to the rightful spending of UK aid. My predecessors worked assiduously to ensure that aid was spent in the right way, and I will continue to build on that.
As for Conservative values, I am speaking very clearly about economic development, prosperity, jobs and empowerment in many of the poorest parts of the world. That is what my Department and I will focus on as we work on the transparency agenda, while also ensuring that those in the poorest countries can look to the future more positively and with more prosperity.

Topical Questions

Gareth Thomas: If she will make a statement on her departmental responsibilities.

Priti Patel: Since my appointment I have visited India, where I called for the delivery of an ambitious UK-India partnership. I have also visited Lebanon and Jordan, where I saw at first hand how UK-funded programmes are delivering education and humanitarian support to the residents of the Zaatari refugee camp. I look forward to working with all our partners throughout the world where British leadership and experience are valued.

Gareth Thomas: Given that a 20% increase in funding for the global fund from Britain is perfectly affordable in the context of Britain’s rising aid budget, and given that such an increase would trigger further sizeable increases in contributions from the United States and from Gates, why can the Secretary of State not tell the House now whether she will meet that 20% request?

Priti Patel: I have already said that I will be doing that, along with my colleagues. I spoke to my Canadian counterpart yesterday about our replenishment of the global fund, and other support. The global fund does amazing work in meeting global objectives. I shall make an announcement about our replenishment this weekend, at the replenishment conference.

Ben Howlett: The sustainable development goals that were agreed in 2015 are crucial to ending poverty, fighting inequality and injustice, and tackling climate change by 2030. What is the Secretary of State doing to implement those goals in the United Kingdom?

Priti Patel: I only just heard my hon. Friend’s question, but I picked up his reference to global goals, which represent a comprehensive plan when it comes to fighting poverty and meeting our strategic objectives. I assure him that my Department is focusing on delivering on those goals, but also on meeting our manifesto pledges on aid.

Stuart McDonald: The Secretary of State’s predecessor kindly agreed to meet the Scottish Minister for International Development and Europe, Alasdair Allan. Will the new Secretary of State commit herself to an early meeting with him, and to positive engagement with devolved Administrations ?

Priti Patel: Again, I only just heard the question, but I think it was based on the need for positive dialogue with colleagues in the Scottish National party. If it was, absolutely: that is exactly what I shall be doing.

David Nuttall: What assessment has my right hon. Friend’s Department made of the humanitarian situation in Venezuela?

Priti Patel: Of course, international assessments of Venezuela note that it is suffering a deep economic crisis and not just with inflation, but also because there is a health emergency there—a shortage of medicines and a humanitarian crisis. Strangely enough, Venezuela’s economic and political policy models have of course been championed by the Labour party, and we can now see what those policies have led to, with the economic catastrophe in Venezuela.

John Nicolson: The Secretary of State’s predecessor said to me that the outcome of the bilateral and multilateral aid review would be published in the early summer. It is lovely weather today, but hardly early summer; when will it be published?

Priti Patel: I look forward to publishing both of the reviews, and since they were draft reviews when I came into the Department, I am looking at them to make sure they meet not just the Government’s priorities, but also DFID’s new priorities. I look forward to publishing them later this year.

Nigel Evans: I recently visited Uganda and was proud to see British taxpayers’ money being used to vaccinate children against all sorts of diseases, but rubella is one area where we are failing to help. Please can my right hon. Friend look at ways in which we could use international development aid to vaccinate children against this hideous condition?

Priti Patel: My hon. Friend raises an important point. The UK is the largest donor to GAVI, the Vaccine Alliance, which protects children from rubella through measles and rubella vaccinations, and of course GAVI has been set up very much to do exactly what my hon. Friend says. We have the UK aid match scheme, and Sense International has received over £200,000 for this very purpose in Uganda and Kenya in particular. I look forward to hearing from my hon. Friend about his findings from his visit.

Alison McGovern: Yesterday, the all-party group on Syria—[Interruption.]—met so that we could, with friends from Syria, remember our colleague Jo Cox—[Interruption.]

John Bercow: Order. I really do think that this question in respect of the seriousness of the situation in Syria, and in deference to our late colleague Jo Cox, should be heard in silence.

Alison McGovern: Yesterday, the all-party group on Syria met so that we could, with our friends from Syria, remember our colleague Jo Cox. May I ask the Secretary of State, further to answers she gave a moment ago with regard to besieged areas, what discussions she has had with colleagues in the region about making sure that sufficient resources are stockpiled in nearby areas so that as soon as that humanitarian window opens we can make sure those areas get the help they need?

Priti Patel: The hon. Lady is absolutely right to once again highlight the appalling crisis and the conflict we see in Syria right now. Further to the points I made earlier, with the new cessation of hostilities coming into force we are of course focused on all avenues of access to get humanitarian aid and support into many parts of Syria that have not seen aid or any humanitarian support for a considerable time. With regard to the discussions I have been having, I have been speaking to colleagues in the region and colleagues across government, and I have also been speaking to our international partners about how we can get that aid through to these critical locations.

John Bercow: Thank you, colleagues.

PRIME MINISTER

Deidre Brock: If she will list her official engagements for Wednesday 14 September.

Theresa May: Let me start by paying tribute to my right hon. Friend the former Member of Parliament for Witney, David Cameron.  He has been a tremendous public servant both for his Witney constituency and the country as a whole, and under his leadership we saw the economy being stabilised, more people in work than ever before, and people on low incomes being taken out of paying tax altogether, and this Government will build on that legacy by extending opportunity to all parts of the country.
This morning I had meetings with ministerial colleagues and others, and in addition to my duties in this House I shall have further such meetings later today.

Deidre Brock: Last week, the Prime Minister could not tell us whether she was in favour of staying in the single market. As an Edinburgh MP, can I tell her how important the financial sector is to Scotland’s economy? Will she tell us whether she agrees with her Foreign Secretary that passporting for the financial services is guaranteed to continue after the UK leaves the European Union?

Theresa May: I am not going to give the hon. Lady a different answer from the one I gave the House on many occasions last week, which is that this Government will be working to ensure the right deal for the United Kingdom in trade in goods and services. That includes listening to the concerns that the Scottish Government and the Governments in Northern Ireland and Wales might wish to raise with us. We will be fully engaged with the devolved Administrations. As I said last week, the best thing for the financial sector in Edinburgh and for the economy of Scotland is to be part of the United Kingdom.

Marcus Fysh: Will my right hon. Friend join me in welcoming the figures that show that unemployment in my constituency has halved since 2010 and, crucially, that youth unemployment has fallen by 12% in the last year alone? Will she promote the value of technical skills and of science and engineering in her push for all children to have a good education that enables them to go as far as their talents and hard work will take them?

Theresa May: I am very happy to join my hon. Friend in welcoming the very good employment figures that we have seen today. As he has said, unemployment in his constituency has halved since 2010. That is because we have had an economic plan and built a strong economy. He is absolutely right to say that as we look to provide opportunities for young people, we must ensure that we consider those for whom technical skills and a vocational education are the right route, because what we want is an education that is right for every child so that they can get as far as their talents will take them.

Jeremy Corbyn: I am sure that the whole House will join me, my right hon. Friend the Member for Knowsley (Mr Howarth) and Jane   Kennedy, the police and crime commissioner for Merseyside, in paying tribute to the police constable who was stabbed several times yesterday in the line of duty while trying to arrest a rape suspect in Huyton. We all wish him well and a speedy recovery. I also wish the former Prime Minister well on his departure from this House and in his future life. I hope that the by-election in Witney will concentrate on the issues of education and on his views on selection in education.
I want to congratulate the Prime Minister. She has brought about unity between Ofsted and the teaching unions. She has united former Education Secretaries on both sides of the House. She has truly brought about a new era of unity in education thinking. I wonder if it is possible for her this morning, within the quiet confines of this House, to name any educational experts who back her proposals on new grammar schools and more selection.

Theresa May: First, may I join the right hon. Gentleman in paying tribute to the police constable who was stabbed in Knowsley? One of the events that I used to look forward to going to every year as Home Secretary was the Police Bravery Awards, because at that event we saw police officers who never knew, when they started their shift, what was going to happen to them. They run towards danger when other people would run away from it, and we owe them a great tribute and our gratitude.
I am glad that the right hon. Gentleman has raised the issue of education, because it enables me to point out that over the past six years, we have seen 1.4 million more children in good or outstanding schools. That is because of the changes that this Government introduced: free schools and academies, head teachers being put in charge of schools, and more choice for parents. I note that the right hon. Gentleman has opposed all those changes. What I want to see is more good school places and a diversity of provision of education in this country so that we really see opportunity for all and young people going as far as their talents will take them.

Jeremy Corbyn: I asked the Prime Minister whether she could name any experts who could help her with this policy. Sadly, she was not able to, so may I quote one expert at her? His name is John and he is a teacher. He wrote to me:
“The education system and teachers have made great strides forward to improve the quality and delivery of the curriculum. Why not fund all schools properly and let us do our job.”
The evidence of the effects of selection is this: in Kent, which has a grammar school system, 27% of pupils on free school meals get five good GCSEs compared with 45% in London. We are all for spreading good practice, but why does the Prime Minister want to expand a system that can only let children down?

Theresa May: The right hon. Gentleman needs to stop casting his mind back to the 1950s. We will ensure that we are able to provide good school places for the 1.25 million children in schools that are failing or inadequate or that need improvement. Those children and their parents know that they are not getting the education that is right for them and the opportunities that they need.
Let us consider the impact of grammar schools. If we look at the attainment of disadvantaged and non-disadvantaged children, we see that the attainment gap in grammar schools is virtually zero, which it is not in other schools. It is an opportunity for young people to go where their talents will take them. The right hon. Gentleman believes in equality of outcome; I believe in equality of opportunity. He believes in levelling down; we believe in levelling up.

Jeremy Corbyn: Equality of opportunity is not segregating children at the age of 11. Let me quote the Institute for Fiscal Studies:
“those in selective areas who don’t get into grammar schools do worse than they would in a comprehensive system.”
The Secretary of State for Education suggested on Monday that new grammar schools may be required to set up feeder primary schools in poorer areas. Will the children in those feeder primaries get automatic places at grammar school or will they be subject to selection?

Theresa May: We are setting up a more diverse education system that provides more opportunities. The right hon. Gentleman appears to be defending the situation we have at the moment, where there is selection in our school system, but it is selection by house price. We want to ensure that children have the ability to go where their talents take them. I gently remind the right hon. Gentleman that he went to a grammar school and I went to a grammar school, and it is what got us to where we are today—but my side might be rather happier about that than his.

Jeremy Corbyn: The two things that the Prime Minister and I have in common are that we can both remember the 1950s and can both remember going to a grammar school. My point is this: every child should have the best possible education. We do not need to and never should divide children at the age of 11—a life-changing division where the majority end up losing out.
I notice that the Prime Minister did not answer my question about feeder primary schools. The Secretary of State for Education said on Monday that the Government
“have not engaged much in the reform of grammars”—[Official Report, 12 September 2016; Vol. 614, c. 614.]
but that they would now start the process. Will the Prime Minister confirm whether existing grammars, such as those in Kent and Buckinghamshire, will now be instructed to widen their admissions policies?

Theresa May: The right hon. Gentleman is right that what we are looking at and consulting on is a diversity of provision in education. We want to make sure that all grammar schools actually do the job that we believe is important—providing opportunities for a wide range of pupils—and there are many examples across the country of different ways in which that is done through selective education. He talks about a good education for every child, and that is exactly what our policy is about. There are 1.25 million children today who are in schools that are not good or outstanding. There are parents today who fear that their children are not getting the good education that enables them to get on in life. I believe in the education that is right for every   child. It is the Labour party that has stifled opportunity and stifled ambition in this country. Members of the Labour party will take the advantages of a good education for themselves and pull up the ladder behind them for other people.

Jeremy Corbyn: I am sorry that the Prime Minister was unable to help anyone in Kent or Buckinghamshire in the answer to my question—presumably, she will have to return to it. This is not about pulling up ladders; it is about providing a ladder for every child. Let me quote to her what a critic of grammar schools said:
“There is a kind of hopelessness about the demand to ‘bring back’ grammars, an assumption that this country will only ever be able to offer a decent education to a select few.”
He goes on to say:
“I want the Conservative Party to rise above that attitude”.
Those are not my words, but those of the former right hon. Member for Witney. Is he not correct that what we need is investment in all of our schools and a good school for every child, not this selection at the age  of 11?

Theresa May: What we need is a good school for every child, and that is precisely what we will be delivering with the policy that we have announced. With that policy, we will see: universities expanding their support for schools; more faith schools being set up; and independent schools increasing their support for schools in the state sector. A diversity of provision of education is what we need to ensure good school places for every child. That good school place is important so that young people can take opportunities and get into the workplace.
I notice that this is the right hon. Gentleman’s fifth question and he has not yet welcomed the employment figures today, which show more people in work than ever before; and wages rising above inflation. That is more people with a pay packet and more money in those pay packets. What would Labour offer? It would offer more taxation and misery for working families. It is only the Conservative party that knows you can only build an economy that works for everyone when everyone has an opportunity for work.

Jeremy Corbyn: Of course I welcome anyone who has managed to get a job; I welcome those people who have managed to get jobs, and keep themselves and their families together. The problem is that there are now almost a million of them on zero-hours contracts who do not know what they are going to be paid from one week to the other.
In order to help the Prime Minister with the expertise on the reform of secondary schools, may I quote to her what Michael Wilshaw, the chief inspector of schools, has said? He said quite simply this:
“The notion that the poor stand to benefit from the return of grammar schools strikes me as quite palpable tosh and nonsense”.
Is not all this proof that the Conservative party’s Green Paper addresses none of the actual crises facing our schools system: a real-terms cut in the schools budget; half a million pupils in supersize schools; a crisis in teacher recruitment and retention; a rising number of unqualified teachers in classrooms; and vital teaching assistants losing their jobs? Is this not the case of a   Government heading backwards, to a failed segregation for the few and second-class schooling for the many? Can we not do better than this?

Theresa May: The right hon. Gentleman has got some of his facts wrong—plain and simple. We have more teachers in our schools today than in 2010. We have more teachers joining the profession than leaving it. We have fewer pupils in supersize classes than there have been previously. I simply say this to him: he has opposed every measure that we have introduced to improve the quality of education in this country. He has opposed measures that increase parental choice, measures that increase the freedom of head teachers to run their schools, and the opportunity for people to set up free schools. Those are all changes that are leading to improvements in our education system, and we will build on them with our new policies.
I recognise that this may very well be the last time that the right hon. Gentleman has an opportunity to face me across the Dispatch Box—certainly if his MPs have anything to do with it. I accept that he and I do not agree on everything—well, we probably do not agree on anything—but I must say that he has made his mark. Let us think of some of the things he has introduced. He wants coal mines without mining them, submarines without sailing them, and he wants to be Labour leader without leading them. One thing we know is that whoever is Labour leader after the leadership election, it will be the country that loses.

Several hon. Members: rose—

John Bercow: Order. May I just point out to the House that progress today at this Question Time session has been absurdly slow? I ask the House on behalf of our constituents to show some respect for those colleagues who want to question the Prime Minister, and I am determined to get down the list. I call Craig Williams.

Craig Williams: Students from Cardiff schools and UK schools attended the recording of the British holocaust survivors giving their testimony for future generations. It was a deeply moving experience for them and a stark reminder to us to fight racism, anti-Semitism and hatred in all forms. As part of this vital education effort, of which I know that my right hon. Friend is a great supporter, is the establishment of a national memorial to the holocaust. Will she update us now on the next stage?

Theresa May: I am grateful to my hon. Friend for his comments. He is absolutely right that we need to ensure that we never forget the horrors of the holocaust and the lessons that must be learned from that. It is right that we have agreed to this national memorial next to Parliament on Victoria Gardens, which is an important place for it to be. My right hon. Friend, the Secretary of State for Communities and Local Government, will today launch an international competition for the design of that memorial. The design may include a learning centre, which will ensure that there will be opportunities for young people and others truly to learn the lessons from the holocaust and to learn about the appalling atrocities that took place.

Angus Robertson: Last week, the Prime Minister was unwilling or unable to give any assurances about remaining in the single European market. Today, she has been unwilling or unable to give any assurances to the financial sector about protecting the passporting of financial services. Meanwhile, millions of people from across the United Kingdom depend on freedom of movement across the EU for business and for pleasure. They face the prospect of having to apply and possibly pay for visas. Is the Prime Minister in favour of protecting visa-free travel—yes, or no?

Theresa May: There was a very clear message from the British people at the time of the referendum vote on 23 June that they wanted to see an end to free movement as it operated and control of the movement of people from the European Union into the UK and that is what we will deliver.

Angus Robertson: The Prime Minister and the UK Government are totally unwilling to tell us the true cost of Brexit and what their negotiating position will be. In contrast, there is a different tune from the European Union. The new EU negotiator, Guy Verhofstadt, has said:
“It’s wrong that Scotland might be taken out of the EU when it voted to stay.”
Does she agree with Mr Verhofstadt and the Scottish Government who want to protect Scotland’s place in Europe?

Theresa May: It is all very well for the right hon. Gentleman to ask that question, but only two years ago he did not want to protect Scotland’s place in the European Union, because he wanted Scotland to leave the UK. On all of those questions, whether it is on the referendum for leaving the European Union, the referendum on independence in Scotland, or those in this House, he seems to think that if he asks the question all the time, he will get a different answer. Well, it will not work for me and it will not work for the Scottish people.

Victoria Atkins: Freedom of speech is a fundamental British value, which is undermined by so-called safe spaces in our universities, where a sense of righteous entitlement among a minority of students means that their wish not to be offended shuts down debate. As students around the country return to their places of learning at the start of this new academic year, does my right hon. Friend agree that university is precisely the place for lively debate, and that fear of being offended must not trump freedom of speech?

Theresa May: I absolutely agree with my hon. Friend. We want our universities not just to be places of learning, but to be places where there can be open debate which is challenged and people can get involved in that. I think everybody is finding this concept of safe spaces quite extraordinary. We want to see that innovation of thought taking place in our universities; that is how we develop as a country, as a society and as an economy, and I absolutely agree with my hon. Friend.

Owen Thompson: Nine-year-old Mohammed is one of thousands of child refugees alone in Syria. His parents fled the country  believing he was dead and have resettled in my constituency. In March, Mohammed was identified as being alive, but has since been kidnapped, badly beaten and left for dead, before being found again. He now lives in fear of daily attacks or sexual violence and assault. Will the Prime Minister agree to meet me to urgently review the steps the Government could take to reunite Mohammed with his devastated family and provide him with the support required to overcome his ordeal?

Theresa May: Obviously, I am not as aware of the details of the individual case as the hon. Gentleman is. The Home Secretary has heard him, and if he would like to write to her with the details, I am sure this case will be looked at. Of course, there are rules that do enable family reunion to take place, and, also, we as a country have committed to take a number of children who are particularly vulnerable—potentially vulnerable—to sexual violence from the region around Syria to ensure that we can resettle them in the UK and take them out of that fear that they are experiencing. But my right hon. Friend the Home Secretary will look at the case if he cares to write to her.

John Baron: What assurance can my right hon. Friend give that, whatever criteria come to guide our immigration system, it will be fairer than the present system—it will no longer discriminate against peoples from outside the EU, as the present system does?

Theresa May: As I mentioned earlier in response to a question, one aspect of the vote on 23 June was that people want us to control movement from the European Union into the UK, and, of course, we are already able to control movement from outside the European Union into the United Kingdom. The details of the system we will introduce for EU citizens are currently being worked on, but I can assure my hon. Friend that we will have the ability to control movement from the EU and movement from outside the EU, and therefore bring that greater degree of fairness that I think people were looking for.

David Winnick: How can the Prime Minister try and justify reducing the House of Commons to 600 Members, while the House of Lords now has 820 Members and, certainly by 2020, will have even more? Is this her idea of democracy in the 21st century?

Theresa May: Of course, the House of Commons voted for that reduction in the number of Members of Parliament—I think people wanted to see that. I would gently remind him that, when he refers to the House of Lords and changes in the House of Lords, it is actually this Government who have introduced the retirement procedures for the House of Lords that have seen a reduction in the number of Members of the House of Lords.

Lucy Frazer: The NHS “Five Year Forward View” states that, in future, we will see more care delivered locally. Does the Prime Minister think that, in line with that, the Cambridgeshire and Peterborough clinical commissioning  group ought to consider the importance of local care when assessing the future of the Princess of Wales minor injuries unit in Ely?

Theresa May: My hon. Friend is right: the five-year plan does include that proposal for more local input in terms of care at a local level. It is absolutely right that in looking at, for example, the future of minor injuries units, local people should be considered and local concerns taken into account. I understand that there is due to be a meeting in Ely later this month to consider this. I hope that she and her constituents will be able to make their views known at that meeting.

Richard Burden: Tomorrow I will be helping to launch a programme at the engineering company ADI Group in my constituency to boost the interest of 14 to 16-year-olds in engineering skills. No doubt the Prime Minister would like to join me in congratulating ADI Group, but will she take it from me that her words of congratulation would mean rather more if they were not accompanied by cuts of between 30% and 50% in apprenticeships funding—a programme that the Institute of the Motor Industry has described as a “car crash”?

Theresa May: I am of course happy to commend the company that the hon. Gentleman has referred to. Of course, the west midlands is an important driver in terms of engineering skills in this country. But I simply do not recognise the situation that he has set out in relation to apprenticeships. We have seen 2 million apprenticeships created over the last six years, and we are committed as a Government to seeing more apprenticeships being created. That is giving young people, like the young people I met when I went to Jaguar Land Rover, opportunities to learn a skill to get into a job, to get into the workplace, and to get on where their talents will take them.

Fiona Bruce: Does the Prime Minister agree that the life chances of many children, particularly in our poorest areas, are limited through living in chaotic and unstable households? Will she kindly look at the report recently produced by the all-party parliamentary group on children’s centres, which recommends family hubs in local communities and other solutions to this issue, with a view to considering this further?

Theresa May: I commend my hon. Friend on the work that she is doing in the all-party parliamentary group. The stable family background that young people are brought up in is obviously important, and she has been a champion for families and for family life. I have set up a policy group led by my hon. Friend the Member for Mid Norfolk (George Freeman). I will ask him to look very carefully at the report that has come out of the all-party parliamentary group to see what we can take from it.

Alex Cunningham: On Monday, the parliamentary advisory group on carbon capture and storage published a report about the potential of CCS to create thousands of jobs, save the country billions of pounds, and play a major role in meeting the UK’s emission reduction targets. CCS is critical to  Teesside, so will the Prime Minister tell the House when the Government will publish their long-awaited new strategy?

Theresa May: The issues of climate change, reducing emissions, and our energy policy are very important to this Government. We have a fine record in this area, and we will be continuing with that. The issue of carbon capture and storage has been looked at carefully in the past. One of the key issues is the cost. We will continue to invest in the development of CCS. We are investing over £130 million to develop the technology, through innovation support, with the aim of reducing its costs, and so we will continue to look at the role that it can play.

Mary Robinson: As a governor at Nevill Road Infant School in Bramhall, I know that schools have to make the best use of their resources. I was therefore shocked to learn that schools in the north-west are charged £27 million for their water. Does the Prime Minister agree that schools are important community hubs? Will the Government make representations to Ofwat to change the banding guidance so that schools are considered to be community assets rather than classified in the same way as big business?

Theresa May: I commend my hon. Friend and others in this House who play a role as school governors—a very important role. She is right that schools need to think carefully about how they are using their resources. The approach taken by water companies does vary. However, we are looking at the guidance to water companies in relation to how they can deal with schools and whether they could be looking at using more concessionary rates for schools.

Tom Elliott: The Prime Minister may be aware of last  week’s BBC “Spotlight” programme on serious allegations of corruption and fraud around the National Asset Management Agency’s sale of properties in Northern Ireland. Will she confirm which agencies will be investigating them, whether the National Crime Agency will be involved, and whether a report will be published in due course?

Theresa May: On the specific issue raised by the hon. Gentleman, I will come back to him on the details. As he knows, the National Crime Agency operates in Northern Ireland on a slightly different basis from that on which it operates elsewhere across the United Kingdom. Where issues are being looked into, it will be necessary to ensure that the appropriate skills and capabilities are brought to bear. If I may, I will write to him with a detailed answer to his question.

Theresa Villiers: Will the Prime Minister give her full and enthusiastic support to President Anastasiades and Mustafa Akinci as they reach a crucial stage of their negotiations, which we hope will deliver a negotiated settlement for a free and united Cyprus?

Theresa May: I am happy to join my right hon. Friend in doing that. It is important. I think that everybody across this House will wish those talks well and hope that they will have a successful conclusion.

Lisa Nandy: It has been two years since the Prime Minister set up the child abuse inquiry, which is now on to its fourth chair, and last week the outgoing chair said that it had become inherently unmanageable. Given that the Prime Minister appointed Dame Lowell Goddard to her position, will she insist that she comes before this House to explain herself? Surely child abuse survivors deserve an explanation.

Theresa May: On the process point, it is not for the Prime Minister to insist who attends before a Committee of this House. I understand that Dame Lowell Goddard has been invited to attend the Committee. I think that the hon. Lady and I share, as do many hon. Members across this House, a desire to see the issues of these appalling crimes of child abuse being properly looked into. That is important. Dame Lowell Goddard has set up the inquiry and the truth project. Many aspects of it are already in place and operating, and I am very pleased that Alexis Jay has taken on the role of chairman of the inquiry. She chaired the Rotherham work, and I think that she will do this work extremely well and we will have answers to questions that so many have been asking for so long.

Lucy Allan: Child sexual exploitation is an issue that affects many communities. Does the Prime Minister agree that shining a light on the events of the past is the best way to learn lessons for the future, and will she agree to an independent review of child sexual exploitation in Telford?

Theresa May: My hon. Friend has just shown the cross-party concern that there is on the issue of child abuse and child sexual exploitation. It is absolutely right, as she says, that we are able to look into the abuses and crimes of the past. We will need to learn important lessons from that as to why institutions that were supposed to protect children failed to do so. It is for the authorities in Telford to look specifically at how they wish to address those issues in Telford, but I am sure that my right hon. Friend the Home Secretary has heard my hon. Friend’s comments and that she will want to take that up with her.

Diana R. Johnson: Following the successful Hillsborough independent panel, will the Prime Minister consider setting up a similar review of the biggest treatment disaster in the history of the NHS, namely the contaminated blood scandal? Victims are still waiting for answers and justice 35 years on.

Theresa May: The hon. Lady obviously raises a very important point in relation to contaminated blood. I will take it away and consider it. Obviously, she will know the reasons and background that led to the Hillsborough independent panel, but I recognise people’s concerns about contaminated blood and will consider the point that she has made.

Shailesh Vara: The Prime Minister will be aware of coverage regarding a report to be published by Dame Louise Casey, the Government’s integration tsar. The report will speak  of British laws, culture, values and traditions, such as Christmas, being threatened by political correctness  from council officials. Will the Prime Minister take this opportunity to send a loud and clear message that the best way to secure a harmonious society is not only for mainstream Britain to respect minority traditions, such as Diwali, Vaisakhi and Eid, but for council officials to appreciate that minority communities should respect the views and traditions of mainstream Britain, which means that Christmas is not “Winterval” and that Christmas trees are not “festive” trees?

Theresa May: I agree with my hon. Friend. I will not comment on or pre-empt the findings of Louise Casey’s review, which is an important piece of work. I will simply join my hon. Friend by saying that what we want to see in our society is tolerance and understanding. We want minority communities to be able to recognise and stand up for their traditions, but we also want to be able to stand up for our traditions generally, and that includes Christmas.

Nigel Dodds: Will the Prime Minister look carefully at the calls from the Royal British Legion and Poppyscotland for new questions to be added to the next census so that we can better meet the needs of our serving personnel in the armed forces, our veterans and their families? In relation to Northern Ireland, where such a massive contribution is made to the armed forces through recruitment and service, will she look carefully at the distribution of funding under the armed forces covenant so that there is equitable funding across all regions and countries of the United Kingdom?

Theresa May: Of course, I am pleased that it was this Government who introduced the military covenant, and who have recognised the importance of that bond and that link with those who are serving in our armed forces and with veterans of our armed forces. I have not seen the specific request from the Royal British Legion and Poppyscotland, but that will certainly be looked at by the Cabinet Office when considering the next census.

David Tredinnick: Does the Prime Minister agree that the co-operation between Russia and the United States in respect of Aleppo sets a very  important precedent, and that it is in the British national interest to redevelop our links with Russia? We may then be able to solve many more problems in that region.

Theresa May: My hon. Friend is right that the agreement that has been reached between Russia and the United States about Syria is an important agreement, and I think everybody in this House will want to see that being put into practice and working on the ground. There have been a number of occasions when we have seen what appear to be steps forward, and sadly it has not been possible to implement them, but I hope that it will be different this time. It would mark an important step. We should have no doubt about the relationship that we should have with Russia. It is not a business as usual relationship. I made that very clear when I was responding to the report on the murder of Litvinenko, and we should continue with that position.

George Howarth: May I join my right hon. Friend the Leader of the Opposition, the Prime Minister and Jane Kennedy, the police and crime commissioner on Merseyside, in commending the tremendous bravery of the police officers involved in the stabbing incident in my constituency yesterday, who nevertheless apprehended the suspect? Will the Prime Minister acknowledge that, often in very dangerous circumstances, the police are being asked to do more and more with fewer and fewer resources?

Theresa May: I join the right hon. Gentleman in recognising once again the work of the individual police constable—[Interruption.] I apologise—the three police constables who apprehended the suspect while being under attack. As I said earlier, our police officers bravely go where others would not go in order to protect the public. They do so much in the line of duty and, for some, when they are off duty as well. They are prepared to go and face danger in order to protect us.
On the issue of resources, I remind the right hon. Gentleman that we have protected police budgets over the period of the comprehensive spending review settlement, in the face of a proposal from his Front Benchers that we should cut them by 5% to 10%.

SPEAKER'S STATEMENT

John Bercow: Order. I had hoped to be able to announce today the timetable for the elections to vacant Chairs of Select Committees. It is my understanding—I may, of course, be wrong—that discussions on these matters in the usual channels have concluded, but the Government have still to table the various motions required. I very much hope that they will be tabled very soon. It may be helpful to Members to know that if the House agrees to those motions, it is my fervent hope and expectation that the elections for Chairs may take place on Wednesday 19 October.

Peter Bone: On a point of order, Mr Speaker.

John Bercow: Not now. I will come to the hon. Gentleman. [Interruption.] It may be on that matter, but there is something else that I want to say first. It is always good to keep the hon. Gentleman in reserve; it builds up a sense of eager anticipation in the House.
Michael Carpenter, Speaker’s counsel, retires from the House service at the end of September. Michael was seconded to the House of Commons from the Treasury Solicitor’s Department in October 2000 as counsel for European legislation, and he subsequently became an employee of the House. Michael became Speaker’s counsel in October 2008. He has served this House and, if I may say so, colleagues, he has served me, magnificently. I shall always be grateful to him, and the House should be thankful for his sense of duty, for his immense ability and for his stoicism and fortitude under pressure. I am sure that the House would wish to send its best wishes to Michael and to his family following his retirement. [Hon. Members: “Hear, hear!”]
I am pleased to announce that, following fair and open competition, Saira Salimi will take on the role of Speaker’s counsel in October. Saira is currently the deputy official solicitor to the Church Commissioners, a role that she has held for the last five years. Before that, Saira was a member of the office of the parliamentary counsel for eight years, and she comes to us with a detailed knowledge of the legislative process. I am sure that the House will want to wish Saira well in her new and important role. [Hon. Members: “Hear, hear!”]

Peter Bone: rose—

Stephen Doughty: rose—

John Bercow: I will take points of order now, before we come to the urgent question. I saw the hon. Member for Wellingborough first, and I am slightly anxious that he will burst if he does not have his opportunity ere long.

Peter Bone: On a point of order, Mr Speaker. I am grateful to you for allowing a point of order at this stage. On the issue that you raised—I thank you for bringing it to the attention of the House—obviously the two Whips Offices will be working very hard to ensure that this House has the opportunity to set up Select Committees to scrutinise the Government. But as they  are having some sort of trouble, is there any possibility that we can do something in this House to ensure that it happens before we go into recess? It would be really useful if we could have the election on the day that you specified, because that is my birthday.

John Bercow: It seemed to me, I must say to the House, that there was very good reason to make expeditious progress on this matter in any case. I am sure that there was absolutely no hint of underlying sarcasm in the hon. Gentleman’s observation when he expressed the confident expectation that the Whips on both sides would want to make progress in the establishment of the new Committee and in the election of the vacant Chairs of all the Committees, because of course they will want the Government to be subject to proper and thorough scrutiny. There is very good reason to proceed expeditiously anyway, but the fact that 19 October is also the hon. Gentleman’s birthday provides an added incentive.
The hon. Gentleman asks what can be done. The short answer, as I think he knows, is that I am doing what I can, not very subtly, to indicate that the usual channels really ought to progress this matter sooner rather than later. So far as I am concerned, that means by tomorrow. I hope we are clear.

Stephen Doughty: Further to that point of order, Mr Speaker. Thank you for allowing me to raise this point at this stage. I add my best wishes to Michael, and to Saira as she takes up her new role.
With the changes to the Select Committees, the old Business, Innovation and Skills Committee will probably change to a new Business, Energy and Industrial Strategy Committee. As you will be aware, Mr Speaker, the BIS Committee is one of the constituent Committees of the Committees on Arms Export Controls. Is it your view that the new Committee will take over the role of the old BIS Committee as one of the constituent Committees, and that it would not be correct, as has been suggested in some quarters, for a new International Trade Committee to take over sole responsibility for scrutinising our arms exports controls?

John Bercow: It has to be said that the hon. Gentleman is an ingenious fellow, and he has regularly demonstrated his ingenuity since his election to the House. I do not blame him for seeking to shoehorn in his current preoccupation when we are discussing the timetable for elections to the vacant Chairs of Committees. However, the proper answer for me to give him is that it is not a matter for the Chair. It will be a matter for the Committee concerned to decide. If the hon. Gentleman were afflicted by a sudden bout of self-doubt or reticence, causing him to be reluctant or unable to express his view on this matter, I would be concerned, but he will not be, and therefore I am not.

Kevin Brennan: Further to  that point of order, Mr Speaker. I notice that the Leader of the House is in his place. Would it be in order, for the benefit of the House, for him to rise at the Dispatch Box and put the House out of its misery on the Government’s plan for the dates of the election of Select Committee Chairs?

John Bercow: The Leader of the House is not under any such obligation. It has to be said that normally—I speak with some authority on this matter, as I have known him for 30 years, and we have been next-door constituency neighbours for the best part of 20 years—he is the most accommodating of colleagues.

David Lidington: rose—

John Bercow: I have a feeling that the right hon. Gentleman is about to prove the point.

David Lidington: Further to that point of order, Mr Speaker. If it will help the House, let me say that, as you rightly said, agreement was reached through the usual channels earlier this week about the reconstitution of Select Committees following the changes to Departments. It was clearly right for us to seek full cross-party endorsement for the changes, and that has now been obtained. I have therefore given instructions for the necessary resolutions and changes to Standing Orders to be drafted immediately, and we shall certainly table them as rapidly as we can get them to the House authorities.

John Bercow: I think that is very encouraging. I do not want to embarrass the right hon. Gentleman, but may I just say that he is in some danger, if he is not careful, of being held aloft by Members from all parts of the House? We will leave the matter there for now. I thank the Leader of the House for what he has said, which is encouraging.

TAX CREDITS: CONCENTRIX

Rebecca Long-Bailey: (Urgent Question): To ask the Chancellor of the Exchequer if he will make a statement on Concentrix’s activities in relation to tax credit investigations made on behalf of Her Majesty’s Revenue and Customs.

Jane Ellison: I want to be very clear: the Government recognise the importance of tax credits to individuals and families. We all recognise that it is important for this support to reach the people who really need it. That is why HMRC works hard to check that it is making the correct payments, and to tackle any fraudulent claims. We must acknowledge that error and fraud exist in the system, and should be addressed to ensure taxpayers’ money is spent correctly. As part of this work, HMRC engaged Synnex-Concentrix Ltd in 2014 to help check people’s eligibility. As a result, almost £300 million of incorrect payments have been avoided.
I want to reassure the House on two key points. First, Concentrix has been paid only for making the right decisions; it has not received payment for taking someone’s money away wrongly. Secondly, Concentrix has not been allowed to engage in fishing expeditions or to pick on vulnerable claimants at random. Where there has been evidence to suggest a claim might not be correct, Concentrix has written to claimants to seek further information and confirm their eligibility. I realise—I know this as a constituency Member myself—that it can be stressful for someone to receive such a letter, but it is right that we investigate the full picture, with contributions from claimants themselves, to ensure we make the right payments. That is why both Concentrix and HMRC, where it does the same work, always send a letter and give claimants 30 days to provide information before taking any further action. It is important that people do indeed respond, and that they get in touch if they are struggling to respond to any of the questions.
Despite the best efforts of the staff manning the phones, Concentrix, with the high volume of calls in recent weeks, has not been providing the high levels of customer service that the public expect and which are required in its contract. HMRC has therefore given notice that this contract will not be renewed beyond its end date in May 2017. HMRC is also no longer passing new cases to Concentrix, but is instead working with it as a matter of urgency to improve the service it provides to claimants and to resolve outstanding cases. I can confirm to the House that 150 HMRC staff have been redeployed with immediate effect to help it to resolve any issues people are having with their claims as quickly as possible.
I realise that colleagues on both sides of the House are concerned to get difficult cases resolved and to assist vulnerable constituents appropriately. In addition to the extra resources I have mentioned, I have arranged a drop-in for Members in Room B, 1 Parliament Street between 9.30 and 11 am tomorrow, at which HMRC officials will be available to offer guidance to colleagues, should that be helpful.

Rebecca Long-Bailey: I thank the Minister for her reply. Many hon. Members on both sides of the House have been contacted, as she has been, by distressed and  anxious constituents—often hard-working individuals who have had their tax credits cut unfairly, in many cases pushing them into extreme hardship. Although Labour Members certainly welcome the fact that HMRC has finally taken action by announcing that the Concentrix contract will not be renewed, it is most regrettable that the Government undertook such action only when events were dramatically exposed by the media and, indeed, by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) and my right hon. Friend the Member for Birkenhead (Frank Field).
It remains the case that Synnex-Concentrix will be carrying out these services for another eight months. There is therefore a risk that without radical amendments to the contract itself, service failures will continue. Of most concern is the fact that the payment model arguably creates a conflict of interest, as has been noted by the Social Security Advisory Committee. Will the Minister therefore confirm what arrangements she will make urgently to revise the contract to preserve justice for the claimants?
As the Minister stated, I understand that HMRC will redeploy 150 staff so that claimants can get through to advisers and resolve their claims. Will she confirm how the Government will monitor that? Will the Government now commit to an official investigation into Concentrix’s conduct since it was awarded the contract in 2014, so that we can determine how this situation was allowed to arise? Finally, has she given any consideration to the real prospect of bringing this service back in-house?

Jane Ellison: I will try to answer those questions, but it is worth commenting that this Government, and indeed their predecessors, inherited a very complicated system. In the long term, the right answer is to replace tax credits, as is our intention, because we were bequeathed an unnecessarily complex system. However, we must make the system work while it is in operation, and that is now the focus of our activities.
On HMRC’s decision about the contract, I want to reassure the House that monitoring has taken place regularly throughout the contract. Indeed, HMRC has worked closely with Concentrix. It is the case that, as has been documented, performance has not been good in recent weeks. That has clearly been noted, and we are now taking action on it.
On the contract going forward, as I mentioned in my response to the urgent question, Concentrix will focus on resolving outstanding claims, not opening new ones. In other words, it will deal with those already open in an orderly and appropriate manner. HMRC is putting in additional resource. In particular, I have asked it to focus on the difficult cases—there have been some high-profile examples in recent days—to ensure that we resolve them as quickly as possible so that all our vulnerable constituents are helped and supported.
That is the key focus as we go forward. There is no need to go into inquiries and so on. We have a contract that is monitored on a regular basis. It will not be renewed when it comes to an end in May next year. The focus for all of us in the coming days and weeks—and for me and for HMRC in particular—is on making sure that the outstanding cases are resolved, especially those of the most vulnerable, and that people have the money to which they are correctly entitled.

Desmond Swayne: I have cases of women who have had their tax credits stopped because, they have been told, they are living with a man of whom they have never heard or, indeed, with the tenant of the property prior to them occupying it. Their benefits have been withdrawn. I am not sure that I need advice tomorrow morning in 1 Parliament Street—when, incidentally, the House is sitting. We need to know how quickly those cases can be reviewed.

Jane Ellison: I quite understand my right hon. Friend’s point. The drop-in is there as a facility should Members wish to use it, but it is not an alternative to the HMRC lines already in place. We encourage anyone affected to call the HMRC number on the letters they have received. We are putting significant additional resources into those helplines, with immediate effect, to make sure we can resolve the situation. I am reassured—although obviously I will be talking to HMRC consistently about this—that as soon as the facts of a case are resolved we can get money into people’s accounts in a short number of days.

Stewart Hosie: I am delighted that the Concentrix contract is not to be renewed. It will come as some comfort, at least, to those who have been affected by its activity. That contract was designed to save £1 billion in fraud and overpayment. The Minister tells us some £300 million has been saved. How much of those so-called savings was as a result of false accusations by Concentrix against tax credit recipients? If somewhere between 120 and perhaps many thousands of people were affected, why was the contract not cancelled sooner? The cost of the contract was reputed to be some £75 million. How much do the Government intend to claw back to directly compensate those affected? The Minister tells us, and I am pleased to hear, that HMRC civil servants have been drafted in to clean up the mess, but how much will that cost the taxpayer in additional pay and will the Government be seeking payment from Concentrix to fund that remedial action?

Jane Ellison: I am not able to respond immediately from the Dispatch Box to one or two of the points raised by the hon. Gentleman. My clear priority and that of HMRC at the moment is to make sure that we resolve the outstanding cases, and in particular the difficult cases for vulnerable constituents. We will then turn our mind to some of the other points that he made. We are not renewing the contract, but we intend to continue to bear down on error and fraud. That is important, as there is a lot in the system, but we have had a great deal of success in recent years in reducing it—the amount of fraud in the system has halved from £800 million to £400 million. We need to continue to bear down on that, because money that is fraudulently obtained is money that is not available to taxpayers. It remains vital that we address that matter. But for the moment, my primary consideration is resolving the difficult cases to make sure that we look after our most vulnerable citizens.

Stephen McPartland: I am a big fan of supporting those people who are trying very hard to get on in life and who depend on tax credits. One of my concerns is that over the next eight months those people will still be dealt with by Concentrix and will still  have that fear of being falsely accused and prosecuted, almost, as they go forward. What reassurance can the Minister give that those people will be looked after, and will HMRC carry on with the contract in the future or will it issue it for new tender?

Jane Ellison: I have laid out the arrangements we are putting in place. The contract ends next spring. In the meantime, HMRC will support Concentrix on the outstanding cases—in particular, looking at more complex cases and supporting back-office functions while Concentrix staff focus on resolving already open cases. It is important to have a bit of perspective. Concentrix has assisted the Government and, indeed, the taxpayer in correctly identifying a lot of claims as either erroneous or fraudulent. It is important to keep the matter in perspective, but HMRC has made clear its operational intention not to continue the contract beyond the spring.

Louise Haigh: I thank the Minister and HMRC for reacting so quickly to issues and concerns raised in the House, but several questions remain. What estimate has been made of the current backlog needing to be dealt with by Concentrix and HMRC? How should those people currently being dealt with contact Concentrix—through the current helpline or by contacting HMRC directly? Why were these appalling failures not acted on before they were revealed in parliamentary questions, if HMRC was monitoring the contract so closely? Will HMRC bring the contract back in-house in May next year? Will the Minister today commit to a review of all payment-by-results contracts, which are completely inappropriate in our welfare system?

Jane Ellison: I am aware that the hon. Lady has been very active on this—she has asked a number of parliamentary questions and has shown considerable interest in the issue. It is important to note, and the performance figures support this, that it is only really in recent weeks that performance has not been acceptable. It is not that this has been an acute problem for a considerable length of time. However, performance has not been acceptable in recent weeks.
People should contact the number on the letters they have received. I am aware that there have been problems getting through on the phone in recent weeks, and have tested it out for myself. We are putting in additional resources to allow Concentrix to focus on answering the phones and dealing with outstanding cases while additional HMRC staff resolve some of the back-office issues and some of the complexities, so that people can focus on the immediate issue.
Some more mandatory considerations are coming in, but we think there are around 2,500 cases in the system still to be dealt with at the moment. We expect more to come in because it is that time of year, after people who have not supplied additional information as they were requested to have seen their tax credits stopped. We feel that, with that additional resource, we can resolve that quickly, and that is my focus.

Bob Blackman: Now that the position is that Concentrix is not going to deal with any new claims or cases, will my hon. Friend clarify for the House who, from HMRC or wherever, will deal with  claims of errors, fraud and other problems, so that we send a strong signal to people that that will not be acceptable and that we want to see genuine claimants compensated for losing money that they need?

Jane Ellison: I reassure my hon. Friend that it has always been the case that both Concentrix and HMRC were pursuing matters of error and fraud; it was not the case that only Concentrix was doing so. HMRC will continue to pursue error and fraud cases. In recent years the Government have put additional resource into supporting HMRC’s work on general tax avoidance and evasion, and compliance.

Frank Field: I thank the Minister for her statement and draw the House’s attention to how different that response was from those of the previous Government; I do not believe that we would have had today’s statement had there not been a leadership change, so I thank her for that. Will she pass on my thanks to her colleague, the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Stourbridge (Margot James), for the immediate action she took on the report I submitted on Hermes, whose unlawful use of self-employment HMRC has been asked to investigate?
I have two questions. The worry about this contractor is that to some people it appears to be cutting benefits first and asking questions afterwards, and there is no mechanism for a hotline for MPs to try to sort such issues out. Although I very much welcome her bringing the contract back in-house, it is the only contract that has ever been put in place that has allowed a private company to make decisions about people’s benefit levels, so might she review that?

John Bercow: It is quite cheeky of the right hon. Gentleman to ask two questions and to declare so openly his intention to do so, although it is perhaps not quite as cheeky as the hon. Member for Sheffield, Heeley (Louise Haigh), who asked five questions without making any such explicit declaration at all.

Jane Ellison: I thank the right hon. Gentleman for his comments on the priority given to resolving problems of this nature. It is worth reiterating that, through the contract, we have secured more than £280 million of identified savings in terms of error and fraud. There continues to be considerable fraud, particularly with regard to whether people live singularly in a household. It is important to recognise that the contract has brought important benefits to the taxpayer.
I recognise the right hon. Gentleman’s challenge on the nature of the contract. Such contracts have their place, but they must work appropriately. The contract must work to do the thing it set out to do, but it must at all times work for taxpayers and, above all, for the vulnerable. I will reflect on his wider point if I may, but I give him reassurance on that general point.

Craig Mackinlay: All hon. Members will have received a deluge recently of harrowing cases of people who have had calls from and interaction with Concentrix. They were unsure at first whether the company existed and whether they had received a scam letter, which we see far too often. There has been a poor  delay in opening post, and getting through on the telephone has been next to impossible. That service level is unacceptable in the public sector. Will the Minister confirm that her very strong announcement today, which is welcome, shows that the Government are committed to helping the vulnerable immediately and accurately?

Jane Ellison: I hope we have shown that. We have important contracts across the Government with people to provide services, but clearly they need to be provided to an acceptable standard. The decision is not to renew the contract. In taking that decision, HMRC has clearly taken into account operational performance. The focus for all of us—Ministers, HMRC and individual Members acting in their constituency capacities—is to ensure that our most vulnerable constituents are supported as soon as possible to ensure that the money to which they are correctly entitled hits their bank accounts and they do not have the stress of wondering where the money will come from.

Nigel Dodds: All of us as constituency Members of Parliament can relay stories of how the service contract has worked and been deplorable, but on the jobs that will be lost—some of them are in Belfast—will the Minister tell us what contact she has had with the Northern Ireland Executive, or what contact HMRC has had with the relevant devolved Administrations or regions, about the effect on jobs? What will be done to give support to those who will lose their jobs?

Jane Ellison: It is important to note that the decision has been taken by HMRC not to renew the contract. To that extent, the decision for a private company such as Concentrix on what it does beyond that point is clearly a matter for the company. If the right hon. Gentleman has concerns of that nature, colleagues in the territorial office and the Department for Business, Energy and Industrial Strategy will be happy to talk to him in the normal way. It is important to stress that this is not a decision to end a contract here and now, but a decision not to renew it in the spring.

David Rutley: I welcome the steps the Government have taken to protect the vulnerable in this situation. Will my hon. Friend assure the House that the lessons learned in this case will apply not only to the contract when it is retendered in May, but across Government contracts more widely?

Jane Ellison: I hope I can give that reassurance for the future. To date, it has always been the case that, when the Government contract a supplier to provide a service, it should be provided to the right standard, and that contracts are monitored and we ensure that service levels are acceptable to Members and their constituents.

Helen Jones: Despite what the Minister has said, I have constituents who have had their tax credits cut off with no prior notification, and who have spent up to 70 minutes on the phone trying to get through, which is a huge drain on their resources. Will she tell us whether the contract included penalties for Concentrix if it did not provide an acceptable service  level or answer calls within a set time? If not, who will take the responsibility for negotiating such a flawed contract?

Jane Ellison: Waiting 70 minutes to have a call answered is clearly not acceptable. I can imagine the distress that would cause somebody trying to get through. If you will forgive me, Mr Speaker, and if the hon. Lady will let me, I will write to her about the points she made about the contract—I do not have that detail to hand, and I need to assess what we can say given commercial confidentiality. If I can give her the answers she seeks, I will do so, but I will write to her if that is acceptable.

Robert Jenrick: The National Audit Office found that the Concentrix contract delivered savings of £500,000 in 2014-15 compared with the original estimate of £285 million. It was expected to deliver at best half the original savings planned in the contract. As we have heard, and as we have learned from our constituency postbags, there were a large number of errors in the process. What more can the Government do to improve the tendering process in future, particularly at HMRC, and to improve the managerial capability at HMRC, so that we do not have such mistakes in future?

Jane Ellison: This is a payment-by-results contract. As I said in my response to the hon. Member for Salford and Eccles (Rebecca Long Bailey) at the outset, Concentrix will not be paid when it has not acted appropriately and when it has not got a result. It is important that we get these things right and I take my hon. Friend’s point. I reassure him that HMRC, and indeed Government Ministers, will always seek to get the right contracts. Clearly, when there are lessons to be learned, we must reflect on them and ensure that they are reflected in future arrangements.

Greg Mulholland: Last week in evidence to the Institute for Government, the former Work and Pensions Secretary, the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), admitted that outsourcing to the private sector was not a panacea. Surely after the Concentrix contract fiasco it is time for full review of outsourcing to private companies in the welfare system. Is it not time to look at whether outsourcing is appropriate at all or, if it is to continue, at what better civil service oversight provision is needed to ensure that this sort of thing never happens again?

Jane Ellison: I again urge hon. Members to keep a degree of perspective. Many contracts deliver what we want. It is worth noting that the Concentrix contract delivered more than £280 million in savings to the taxpayer, which represents a sensible return on that investment. I have said what I have said about service levels—they must be acceptable and to the standard we have contracted for—and there are circumstances in which the use of a private companies offers a cost-effective way to get something that the Government might not otherwise have, which could mean flexible capacity or the capacity to do something for an uncertain period. Sometimes, the flexibility that such contracts offer makes it easier than doing something in-house. I take the hon. Gentleman’s points and will reflect on them but I do not draw the same general conclusion as he does.

Rehman Chishti: I welcome the Minister’s statement and concur with the excellent point made by my right hon. Friend the Member for New Forest West (Sir Desmond Swayne). The Minister will know that genuine errors are made by both constituents and HMRC. Going by one’s casework and constituency surgeries, it seems that sometimes full compassion is not shown by HMRC when looking at the circumstances when a genuine error is made. Can we ensure that that is done in those difficult circumstances for those who are most vulnerable and in need?

Jane Ellison: I have had the same experience as my hon. Friend. Only last week in a constituency surgery, I sat with a constituent who had a complex case and who was in a very difficult situation. Obviously, we can take up cases on behalf of constituents, but when constituents ring HMRC, it is important that they explain their circumstances. HMRC will make every effort to resolve the situation quickly. It is very aware of the need to get people sorted out and get money into their bank account, as appropriate, quickly, but I will re-emphasise that—as the House can imagine, I have discussed the issue in recent days. The interest in this urgent question and the points being made on both sides of the House will be seen and heard where they need to be.

Ian Murray: A significant number of my constituents have been left financially disadvantaged as a result of the antics and processes at Concentrix. Can the Minister assure the House that, while the priority is to resolve those cases urgently, she will look seriously into fining the company and using those resources to compensate my constituents for the financial distress they have suffered?

Jane Ellison: To reiterate what I said earlier, I will ask HMRC to advise me on the nature of the contractual arrangements. Again, it might be better if I could write to the hon. Gentleman on that.

Kevin Foster: As a constituency MP who has dealt with a number of cases, I am pleased to note the action the Government have taken. That said, as a member of the Public Accounts Committee I have also sat through numerous reports on the quality of service HMRC provides, which is at times hardly of gold standard. What reassurance does the Minister have that, with HMRC picking up some of this work, we will not see a drop-off in the standard of services elsewhere and in future arrangements?

Jane Ellison: I do not believe that that will be the case. HMRC has been dealing with cases at the same time as Concentrix throughout the period of the contract. I have been assured that the 150 additional staff deployed with immediate effect will be focused on this. I have no reason to believe that any other services will suffer. My hon. Friend’s point is well made and will be re-emphasised to HMRC.

Alison Thewliss: I am glad to hear that the Concentrix contract is ending but, as the Minister said, it will still be dealing with ongoing casework. Will she personally intervene to help a constituent of mine who was plunged into £1,300 of debt through   the incompetence of Concentrix? It failed to process the annual review and refused to acknowledge any of my correspondence. Will she take up this case?

Jane Ellison: Of course. If any Member wishes to write to me, I will ask HMRC to look at it as a matter of priority. The hon. Lady may not be around tomorrow morning, but there is an opportunity, if she or any other Member wants to bring a complex case, to go to the drop-in where HMRC officials will be available. If she would like to write to me, I will of course look at the case.

Jim Cunningham: I first raised this issue last January. It has taken about eight months to get to this situation. The issue, which had been going on for weeks, related to a family who did not have any income over the Christmas period. Why does it take a BBC programme to bring Ministers to the Dispatch Box? On Monday, a member of my staff was given the run-around by HMRC and Concentrix because nobody would take responsibility. My constituents have spent hours on this. To involve the private sector in such a sensitive and humane issue does not work.

Jane Ellison: I am sorry to hear that the hon. Gentleman had that difficult experience. I cannot agree with his general point about there being no role for the private sector in this regard. I refer again to the amount of money that has been saved for the taxpayer. There is a lot of error and fraud in the system, and it is important that we bear down on that. We do not want money to go to people for whom it is not appropriate, in particular in relation to the nature of people’s households. Much of the fraud does rest in that area. As he highlights, this is a particularly difficult and sensitive area to investigate, but we need to continue to investigate it because the amount of fraud in the area of tax credits is considerable.

Mark Durkan: We can all share the stories of our constituents’ anguish and the frustration for our offices in dealing with this debacle, but we should remember that HMRC is itself not an innocent agent. It designed the contract. It put customer hostility and suspicion into the contract, and into the standards of performance and practice. It was, of course, HMRC that provided the names targeted by Concentrix. This has happened against a backdrop of the Government persistently running down the capacity and character of HMRC. Will some of those bigger policy misguidances also be looked at, as well as the enjoyment we are all having today in scapegoating Concentrix itself?

Jane Ellison: I return to the answer I gave a moment ago. We need to continue to bear down on fraud in the system. There is a considerable amount of error and fraud. I am afraid it would be naive to think that all of this is error. There is fraud in the system and there is a lot of error, which the original design of tax credits makes easier. We need to continue to bear down on fraud, but clearly we need to do that in a way that does not make it difficult to assist the most vulnerable.

Sue Hayman: The Minister has mentioned fraud a number of times. There is obviously fraud in the system, but I really do not see that that as an excuse for errors and failures that affect our constituents.  My constituent, Sarah Hodgson, has three young children and is struggling to put food on the table. There is no excuse for incompetent contractors. I am glad the Minister talks about the redeployment of HMRC staff to support people. The HMRC office in my constituency, which employs over 200 people, is due for closure. Our nearest regional office is more than two hours’ drive away and the phone system is clearly not working: it is not helping people with their inquiries. Will she please review the closure of our local offices, so that people can keep the support and the face-to-face contact they need in these situations?

Jane Ellison: I am sorry to hear about the case the hon. Lady mentions on behalf of her constituent. She raises a wider issue about the modernisation project that HMRC is going through. Perhaps it would be more appropriate if she wrote to me. Although the process of modernisation means that some regional offices are closing, it is important because it is fundamentally about delivering a better and more modernised service in the future for all our constituents.

Sammy Wilson: I trust there will be some compensation paid by the company for the ineptness in the way the contract has been handled and the extra costs that have been incurred. A lot of people today have talked about how wonderful it is that this is being brought in-house, but it was not so long ago that this House condemned HMRC for not answering more than half of the telephone calls made by constituents about tax matters. What steps has the Minister taken to ensure that, now that new cases will be brought in-house, there will not be the same problems with HMRC as there were with Concentrix?

Jane Ellison: It is documented that at times in the past HMRC has had problems with answering its phones, but I think that of late some of the information in the public domain is rather out of date. Indeed, performance in answering phones is considerably better and has reached a very good standard in recent weeks. It is important to retain some balance. It is worth noting that Concentrix has amended about 103,000 claims following the checks it has made. I reiterate that this has been an important exercise, but clearly it needs to be done in the right way.

Julie Cooper: I welcome the news from the Minister that Concentrix will not have its contract renewed, but in the meantime I have ongoing concerns on behalf of my constituents. There has been a lot of talk about what is unacceptable, with a focus on fraud. What we are talking about here today are errors that have been made and have caused tremendous suffering. We are not talking about occasional exceptional errors; we are talking about a widespread number of errors that are causing exceptional misery for some families. Let me just share with the House the story of one of my constituents, a single mother of four, whose tax credits were stopped in error. As a result, her claim has been closed down, her children can no longer access free school dinners, she cannot get free milk tokens for her baby, and, more importantly, she has been told that her claim cannot be reopened for 44 days. Will the Minister  assure me that she will intervene, as a matter of urgency, to make sure that this mother can continue to feed her children?

Jane Ellison: I am sorry to hear that the hon. Lady’s constituent has had such a difficult time. Obviously, without knowing the details of the case it is very difficult to comment across the Dispatch Box. I urge her to use the resource I have referred to throughout this urgent question to take up the case. I hope it can be resolved in that way as soon as possible. I have emphasised—HMRC is very aware of this—that speed is of the essence where people have had their tax credits erroneously stopped. She is right that there is error in the system. I reiterate the point that this is a too-complex system, which is exactly why the Government are looking to make major long-term reforms. Even the honest taxpayer can easily fall into error with a system that was so complex in its design from the start.

Tasmina Ahmed-Sheikh: As we sit here, families up and down the country have been required to rely on charity and food banks. To make ends meet, as a result of what can be described only as frankly ridiculous decisions made by Concentrix, our constituents find themselves in a position not of their own making. To this end and given that so many are living a day-to-day existence, will the Minister confirm just how quickly people can expect to be paid the sums to which they are rightfully entitled?

Jane Ellison: It is really important that we get the facts of the case correct and quickly. At the point that that is done—it might be during the course of just one phone call—I am assured that money should be placed into people’s accounts in a matter of no more than four working days. That is what I expect to see. It is a matter of days and it certainly should not be weeks. We need to establish the facts in each instance. It is worth saying again—for the sake of the House having some sense of perspective on this issue—that last year only 1.6% of customers asked for a review of the decision, following a check. Given that a large number of people are being checked, that is quite a large number, but it would be wrong to think that this was a huge proportion of the cases in question. It is important to get things right and, as I say, we look to pay people within days—as soon as the facts of the case have been established.

Diana R. Johnson: The Minister says that HMRC is supporting Concentrix in performing its contract up until it ends next year. What is the cost to the public purse of that support, and is it recoverable from Concentrix?

Jane Ellison: It has always been the case, as we would expect, that managers within HMRC have worked with Concentrix throughout. I do not anticipate that enormous additional costs will be involved. There has always been a relationship between the two because there is some overlap in the work being done. I would expect that to continue as we work towards the end of the contract.

Alan Brown: The Minister is currently engaged in crisis management, but unless she sees the bigger picture, crisis management itself is not going to be good enough. In her opening  statement, she said that Concentrix was not allowed to phish, but it clearly has been phishing. One of my constituents got a phishing letter not only saying that they were going to stop the tax credits, but demanding £10,000 in back payments. It is quite clear that investigation is needed—and soon. Any such investigation needs to look not only at the contract terms, the audit process and Concentrix’s behaviour, but at what is the true resource requirement for dealing with the tax credits issues. Unless the Minister can confirm such an investigation and review, we will be back here in a couple of years’ time.

Jane Ellison: HMRC has data analytics and operational experience to deliver the kind of savings we are looking for in reducing error and fraud. Practical measures such as simplifying the tax credit system, better monitoring of changes of income through real-time information and improved detection of fraud will obviously go forward. They are all important parts of making sure that we improve performance. It is worth noting again that hundreds of millions of pounds to the taxpayer have been saved by reducing error and fraud. We want to make it harder for people to make errors in the future.

Alison McGovern: As long as I have represented them, people in the Wirral have been treated with disrespect and indignity by HMRC. This is only the worst of a long series of cases. Let me ask the Minister one simple question: when did she first meet Concentrix to raise our concerns with them?

Jane Ellison: I have been a Minister in this Department since mid-July. I have not met Concentrix because I have not been the Minister for that long. Clearly, however, my predecessor colleagues have done so. I have been working with HMRC on regular monitoring. Given the interest from colleagues of all parties in recent weeks, I have been getting daily updates from HMRC on terms of performance. In the relatively short time I have been in my post, particularly in view of the summer recess,  I have not had a chance to meet Concentrix. On the hon. Lady’s general point, I am sure that HMRC will be disappointed to hear it, but I am also sure that it will want to reflect on her words.

Carol Monaghan: One issue reported by my constituents is the requirement to send all the documentation by registered post, which costs over £13—money that they can ill afford when they are living on the breadline. During the eight months in which Concentrix will continue to have this contract, will the Minister look urgently at alternative methods of providing documentation?

Jane Ellison: I will certainly ask that question, but I cannot give any assurance that it will be possible to alter the situation during the time that the contract has left to run. The hon. Lady highlights an important point about where we go in the future with these sorts of systems. It further highlights the fact that the more we can make these things digital and make it easier for people to get right, the more likely we are to avoid these sorts of unhappy situations.

Gavin Robinson: The Financial Secretary should know that I tabled five questions on this issue on Monday, and that I am well alive to the issues that many colleagues have raised this afternoon. With 1,800 people employed by Concentrix in Belfast and with Concentrix redeveloping on to one location in the city, will the Financial Secretary reflect on how appalling it was that members of staff—many of them my constituents—found out about this news last night only by a tweet from the BBC rather than through any communication from Concentrix or indeed any statement to this House?

Jane Ellison: As I have said a number of times, the contract is not going to be renewed; it has not been terminated. To that extent, consideration of whether any contract is renewed is something that will take place in the normal course of events. The hon. Gentleman provides me with an opportunity to place on record my thanks to the many Concentrix staff who are working hard at their jobs and trying to resolve problems. At the same time as we shine a light on areas where performance is unacceptable, it is really important to take the chance to reflect on the fact that many people are working hard to do their jobs as well as possible to provide a good level of service. Indeed, many people are succeeding in that regard.

Owen Thompson: I know the Minister says that she sees no need for an inquiry, but I and many colleagues in the Chamber today—and certainly many of our constituents—very much disagree with that position. My question is: how can we learn the lessons to ensure that the practices employed by Concentrix never come to light again if we do not look into the practices carried out by Concentrix through some form of investigation or inquiry?

Jane Ellison: In the normal course of events, we would always look to how things should be arranged in the future after reflecting on what we can learn from things that have already happened. That would happen through a normal process of review and consideration. We shall have to agree to differ on the issue of whether an inquiry is needed.

Christina Rees: I have been contacted by many distressed women in my Neath constituency about how awful Concentrix really is. Some Concentrix advisers have suggested to mums, who are desperately trying to renew their tax credits, to get payday loans to feed their children while their claims are being processed. A group has been formed, called “Concentrix Mums”, whose more than 5,000 members can share their horror stories. Let me provide just a couple.

John Bercow: No. I think one will suffice.

Christina Rees: One it is, Mr Speaker.

John Bercow: I fear the hon. Lady has caught what might be called “the Burnley condition”.

Christina Rees: I hope not. Does it involve shoehorning? One mum had not eaten for three days so that she could feed her children. This is sickening: it should be stopped and it should have been stopped a long time ago.

Jane Ellison: I am aware of the Facebook group that the hon. Lady mentions, and I am also aware of some of the cases that have been documented there. To end where I began, that is exactly why we are deploying additional resources to make sure that we can deal with the most difficult cases for the most vulnerable people as quickly as possible. That will be my focus and that of HMRC in the coming days.

Point of Order

Gareth Thomas: On a point of order, Mr Speaker. During International Development questions this morning, the Secretary of State said that she would make an announcement on future funding of the global fund at some point next week. It is true that the global fund replenishment conference will take place next week and therefore represents a hard deadline, but given the scale of taxpayers’ funding that is at stake—up to £1.2 billion, hopefully—should not we in the House of Commons, representative as we are of the British taxpayer’s interests, be informed before any briefings are made to the media or to other countries?

John Bercow: It is a matter for Ministers. Announcements can be made during recess periods, and frequently are, but if the Government know what they intend to announce, I would hope that they would be sensitive to the prior claim of Members of this House to be informed first, rather than the information being disseminated through the media or to some other less deserving source. I hope that that deals with the issue for now; I am genuinely grateful to the hon. Gentleman for raising it.
These matters usually end up having to be announced to the House anyway. We had a case of that some days ago, when, frankly, it would have been better for an earlier statement to be made to the House on grammar schools. It was not made as early as it should have been, but when it was eventually delivered to the House, I did ensure that everyone questioned the relevant Minister, and a considerable allocation was therefore required. It is always better, really, if the Government anticipate these things in the first place, rather than waiting until later than is necessary.

BILLS PRESENTED

Small Charitable Donations and Childcare Payments

Presentation and First Reading (Standing Order No. 57)
Mr Chancellor of the Exchequer, supported by Secretary Karen Bradley, Mr David Gauke, Jane Ellison, Simon Kirby, Caroline Dinenage and Mr Rob Wilson, presented a Bill to make provision about the payment schemes established by the Small Charitable Donations Act 2012 and the Childcare Payments Act 2014.
Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 68) with explanatory notes (Bill 68-EN).

Health Services Commissioning (Equality and Accountability)

Presentation and First Reading (Standing Order No. 57)
Rehman Chishti presented a Bill to make provision to reduce inequalities in the health care received by people with mental illness and learning disabilities; to require commissioners of health services to make an annual report to the Secretary of State on the equality of service provision to, and the health outcomes for, such people and of their qualitative experience of health care services; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 2 December, and to be printed (Bill 67).

Air Quality (Diesel Emissions in Urban Centres)

Presentation and First Reading (Standing Order No. 57)
Geraint Davies, supported by Mrs Margaret Ritchie, Rob Marris, Alex Cunningham, Thangam Debbonaire and Tulip Siddiq, presented a Bill to make provision about urban air quality targets relating to diesel emissions; to require vehicle emissions targets and testing to reflect on-road driving conditions; to make the removal or disablement of pollution-reducing devices in vehicles a criminal offence; to provide powers for local authorities to establish low diesel emissions zones and pedestrian-only areas and to restrict the use of roads in urban centres by diesel vehicles; to promote the development of trams, buses and taxis powered by electricity or hydrogen in urban centres for the purpose of improving air quality; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 18 November, and to be printed (Bill 69).

Sugar in Food and Drinks (Targets, Labelling and Advertising)

Presentation and First Reading (Standing Order No. 57)
Geraint Davies, supported by Graham Jones, Alex Cunningham, Julie Cooper, Louise Haigh, Mark Durkan, Tommy Sheppard, Sir David Amess, Dr Philippa Whitford and Dr Julian Lewis, presented a Bill to require the Secretary of State to set targets for sugar content in food and drinks; to provide that added sugar content on food and drink labelling be represented in terms of the number of teaspoonfuls of sugar; to provide for standards of information provision in advertising of food and drinks; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 4 November, and to be printed (Bill 70).

John Bercow: Truly, the hon. Member for Swansea West (Geraint Davies) will prove to be a busy bee.

Geraint Davies: I am buzzing away now.

John Bercow: The hon. Gentleman is buzzing away now, as he helpfully and originally points out.
We now come to the ten-minute rule motion, which the hon. Member for Dover (Charlie Elphicke) has been so patiently waiting to move.

EUROPEAN UNION (UK WITHDRAWAL FROM MEMBERSHIP)

Motion for leave to bring in a Bill (Standing Order No. 23)

Charlie Elphicke: I beg to move,
That leave be given to bring in a bill to implement the withdrawal of the United Kingdom from membership of the European Union; and for connected purposes.
The House knows that the position of the Government is very clear. Brexit means Brexit, and we will make a success of it; also, Brexit means Brexit, and we need to get on with it. I think it important for us to understand, agree with, and endorse the position that the matter of article 50 is a matter for the Prime Minister alone. She has the mandate of the masses, given to her—or to the Prime Minister, and the Government—on 23 June, and it is right for her to invoke it. I believe that the sooner she invokes it the better, so that we have the security, the stability and the certainty that we need as we seek to build a post-Brexit Britain.
I am introducing the Bill first to give the House an opportunity to endorse and accept the decision of the British people on 23 June; secondly, to talk about the red lines that the British people clearly identify in terms of what Brexit will look like; and thirdly, to talk about the vision that we can have for the post-Brexit Britain that we will build.
First, let me deal with the issue of where Members of Parliament stood when it came to the referendum. As the House knows, I was very concerned about the border between Calais and Dover: I did not want it to move back from Calais to Dover. The British people did not share my concerns, and I am here today to say that that is their decision, and we must endorse it.
This is an opportunity, in particular, for the Labour party to reject the talk of the hon. Member for Pontypridd (Owen Smith), who says that we should have a second referendum to drag the British people back into the European Union. It is an opportunity for the Labour party to say, “We accept and we will submit to the will of the British people, and we will help to make Brexit a success.” I also say to members of the Scottish National party, who do not seem to like the result of any referendum that is held in these isles, “Do not be the Scottish Neverendum party.” I ask them first to accept the decision of the Scottish people, by an overwhelming majority and with an overwhelming turnout, to remain part of the United Kingdom, and secondly to accept the decision of the British people as a whole that this country, this nation, this United Kingdom, should seek a future outside the European Union. I say to them that it would be wrong to think that “If at first you don’t succeed, vote, vote again” should be their motto. That would be the wrong approach.
Let me now deal with the red lines. It is clear that the British people are deeply concerned about the level of uncontrolled EU immigration. They were told, and it was pledged in manifestos, that net migration would be brought down to tens of thousands, but last year the figure was 330,000. People in Dover tell me regularly that they are very concerned about the downward pressure that that exerts on their wages, and their concern has  been underlined and proved right by important research conducted by the Resolution Foundation which shows that, on average, the mass migration that we have experienced has caused wages to be about £450 lower for the hard-working classes of Britain. According to the foundation, if we did succeed in bringing migration down to tens of thousands, they would have a pay rise. Work by the OECD, published in 2014, emphasises that mass migration does not benefit, and has not benefited, the people of Britain or those in the rest of the world. It does not have an economic good, and it does not work for the British people in their daily lives. That red line is crystal clear: we must end uncontrolled EU immigration.
The second red line—which was confirmed by Lord Ashcroft’s recently published poll—is also very clear. People do not want billions for Brussels: that has to end. We cannot have any kind of Brexit deal that includes the handing over of billions to Brussels. Instead, the money should be spent here at home, and invested in Britain. My constituents say that we need a renaissance for the towns and regions of Britain, and we need to use that money wisely—which brings me to my final and most important point.
What is the post-Brexit Britain that we are going to build? What will this country look like? My constituents say to me, “It always seems to be about investing in HS2, or runways at Heathrow, or £4.7 billion for Crossrail. It always seems to be about benefiting London, or benefiting the jet-set elite. What about us in Dover? Why has the A2 not been dualled? We have been waiting for that project for decades.” Every single region in the country will be able to specify an infrastructure project for which it has been waiting for a long time, while things always seem to work for the jet-set elite and the metropolitan populace in London rather than for other towns and regions. We need a rebalancing for the 90% who live in the towns and regions of this nation, rather than the other 10%. It is time that Britain worked for everyone. It is time that public expenditure worked for everyone as well. London receives about £10,000 of public expenditure per head, while the figure for the south-east is less than £8,000. That is a difference of some 26%. My constituents say, “The allocation of resources in this country is not fair. When we get this money back from Brussels, there will be an opportunity to make it fairer.”
It comes down to this question: who does Britain work for? Who do my constituents, and the constituents of the towns and regions of this nation, feel that Britain works for? They feel that it too often works for the Philip Greens of this world, for the privileged few rather than the hard-working-class kids of Dover and Deal and Doncaster and Darlington, and they think that that needs to change. First, big business needs a change of culture. We all know how Apple has been gaming the tax system and paying hardly any tax in this country: it is a bad Apple. We also know that Amazon has a Luxembourg structure. We should look closely at its books, and I hope that HMRC will do so. On Google, we need to make sure that the Public Accounts Committee is supported in its searching, and make sure that Google pays a fair share of tax in this country. When it comes to car rental businesses like Avis, it just shows that we are being taken for a ride when, the other  day, it imposed a Brexit tax on Britons but is not paying any corporation tax to Britain because it has a Luxembourg structure. It is that kind of thing that drives the people of Dover and Deal round the bend and we need to call a stop to it. We can do that when we leave the EU very simply, because we will not be struck by their anti-discrimination rules that make it so hard for us to secure our tax base.
We need to make sure that Britain works for the people as a whole, rather than have the bloated boardroom bonuses we have seen too much of in recent years. The ground-breaking research of my hon. Friend the Member for Croydon South (Chris Philp) recently showed that pay in the boardroom for chief executives is 150 times that of employees of FTSE 100 companies. That is not right, and that has doubled in the last 12 years. When a shareholder vote rejects that, companies like BP just say, “Well, we’re not accountable to you; we’ll do what we like.” That culture needs to change.
We need to have a country that works for everyone, not just the privileged few. It is important that we make sure that we have more investment for the regions—that we have runways in places like Bristol and Birmingham and Manchester and that we have railways and roads that work for everyone in the regions. It is important that we have bigger investment.
Finally, I simply say that Brexit means Brexit. We are going to make a success of it, but it is also an opportunity to change how we run Britain, to change our national way of life and who our country works for and make sure it works for literally everyone, rather than just the privileged few, which is how people have felt for too long. That is the kind of change we can make.
It was the towns and regions of this country that decided to take us out of the EU, and they should be supported in leading the charge for the kind of future we can build as we head out into the single market of the world.

Stewart Hosie: I want to decline the right of the hon. Member for Dover (Charlie Elphicke) to bring in his Bill. He said that we in Scotland, the Scottish National party in particular, should respect the decision and the outcome of the referendum. I very much respect the decision of those nations who voted to leave the EU; I would simply say to my friend from Dover that perhaps he and his colleagues should respect the wishes of those nations who voted to remain in the EU.
It is always sweet to be chided by the hon. Gentleman, who railed against the jet-set elite and talked about the imbalance in boardroom pay. We do not need to leave the EU and destroy our trade opportunities to tackle the imbalance in boardroom pay. He talked about the imbalance in public spending, and he was right to do so; indeed, other parts of the country—the east of England, the north-west of England—get even less than the south-east gets, such is the imbalance. But we do not need to leave the EU and weaken job opportunities and export opportunities to rebalance public spending throughout the English regions. If only we had an English Parliament to deal with these things, then things would be so much better. The hon. Gentleman spoke about corporate tax and how little is paid by some of the Goliaths of the global corporate world. We do not  need to leave the EU and weaken opportunity further in order to deliver fairness in corporate taxation.
In essence, though, the hon. Gentleman made a pitch to leave now because, he said, “Brexit means Brexit” and we will “make a success of it”; I think I am quoting accurately. The problem, and the reason why no one can support this ten-minute rule Bill, is that when the Prime Minister—the leader of Government, the high heid yin of the Tory party—is asked, “If Brexit means Brexit, does it mean we will be staying in the single market?”, she does not know. When she was asked the most straightforward question earlier today—“Will the passporting in place for financial services be maintained?”—she said “I refer you to the answer I gave last week,” which is, “I don’t actually know.”
So on the basis that “Brexit means Brexit” is no more than a meaningless campaigning expression, and that none of the benefits described by the hon. Gentleman in terms of Brexit—tackling corporate pay and corporate taxation, tackling the imbalance in regional public expenditure in England—will in any way, shape or form be addressed, let alone improved, by Brexit, I fear we are going to have to call against the hon. Gentleman’s valiant attempts to drag the whole of the UK, including those parts who voted to stay in, out of the EU before there is even a plan.
Question put (Standing Order No. 23).
The House divided:
Ayes 50, Noes 179.

Question accordingly negatived.

SOCIAL SECURITY

Damian Hinds: I beg to move,
That the draft Welfare Reform and Work (Northern Ireland) Order 2016, which was laid before this House on 6 July, be approved.
The order will ensure that the welfare reforms enabled by the Welfare Reform and Work Act 2016 in Great Britain are delivered in Northern Ireland while also ensuring that the Northern Ireland Executive have a workable budget. This order is an important part of delivering the “Fresh Start” agreement and will enable the Northern Ireland Executive to provide for supplementary welfare payments from within their own budget. Before the “Fresh Start” agreement, the impasse on agreeing the implementation of welfare reform meant that the Northern Ireland Executive had been operating on an unworkable budget. This had created significant political instability and it risked collapsing the devolution settlement.
This order today brings changes that will help to ensure that the budget of the Northern Ireland Executive is placed on a stable footing. We want to work with the Executive to support a Northern Ireland where politics works—a Northern Ireland with a stronger economy and a stronger, secure and united society. It is in the light of these goals that the Government have agreed to legislate on behalf of the Executive to enable the welfare reform changes in the Welfare Reform Act 2012 and the Welfare Reform and Work Act 2016 to be implemented. Those changes include the introduction of universal credit, personal independence payments and the benefit cap. This formed an integral part of the “Fresh Start” agreement in November last year.
The Welfare Reform (Northern Ireland) Order passed in December last year has enabled the making of more than 30 sets of regulations replicating in Northern Ireland the welfare reforms in the 2012 Act. The order before the House today is the next step in that process. It has been drafted with the full consent and collaboration of the Northern Ireland Executive to bring social security in Northern Ireland back to a position of parity, thereby helping to rebalance and strengthen the finances of the Executive.
Across the UK, our welfare reforms have focused on supporting people to find and keep work. They have focused on employment, fairness and affordability while supporting the vulnerable. Over the past six years, we have stuck to our economic plan, delivered welfare reform and seen great progress, with employment up 2.7 million. Broadening life chances is an essential part of this Government’s plans. In Northern Ireland, the raising of tax thresholds will take 110,000 of the lowest paid people out of income tax altogether, and 700,000 people will benefit from reduced taxes. Also, 100,000 people in Northern Ireland are projected to benefit from the national living wage by 2020. The Government’s support for working people goes hand in hand with the welfare reform programme to encourage people into work.
We have also invested in Northern Ireland. The Stormont House and “Fresh Start” agreements included financial packages of £2.5 billion to support investment and reform. This includes £350 million of additional capital  borrowing explicitly for economic development projects. By working together, the Government and the Executive have achieved significant successes, including bringing £60 million of additional finance to Northern Ireland businesses, providing additional borrowing for shared education projects and boosting green investment by £70 million.
In Northern Ireland, 55,000 more people are in employment than in 2010, but there is much more still to be done. The most recent Northern Ireland unemployment rate of 5.6% is above the overall UK average of 4.9%. The percentage of unemployed people who have been out of work for more than a year is 47.%—markedly higher than the UK average of 27%. Some 22% of working-age households in Northern Ireland are workless compared with 15% in the UK as a whole.
The Welfare Reform and Work Act 2016 built on the 2012 reforms, and this order provides the legislative framework to replicate some of its most important aspects, including changes such as improving fairness in the welfare system by changing the level of the benefit the cap. The order will ensure parity by bringing the cap that exists in Great Britain to Northern Ireland. Changes also include providing new funding for additional support to help employment and support allowance and universal credit claimants with health conditions and disabilities into work and removing the ESA work-related activity component, so that the right support and incentives are in place for those who are able to take steps back to work. The unsustainable rise in benefit levels compared with earnings will be corrected by freezing most working-age benefits. Importantly, the changes will help to ensure that the budget of the Northern Ireland Executive is placed on a stable footing.
It was agreed in the “Fresh Start” agreement that the Executive could supplement benefits from within their own budget. The agreement allocated up to £585 million of the Executive’s block grant over four years to provide for supplementary welfare payments in Northern Ireland and that will be reviewed in three years. Under the 2015 order, the Assembly has already passed some regulations for supplementary welfare payments relating to the 2012 reforms. The provisions of this order will give the Assembly the ability to design and pass further such regulations, including supplementary payments to those affected by the removal of the spare room subsidy. These time-limited payments follow the recommendations of the Evason report, which flowed from a commitment in the “Fresh Start” agreement.
The order is about delivering the “Fresh Start” agreement and returning Northern Ireland to a position of legislative parity and financial stability, and I commend it to the House.

David Anderson: I thank the Minister for bringing this order to the House, but it is a shame that the matter could not have been resolved in Northern Ireland. The order is the result of months of negotiations and an attempt to break budgetary deadlock and avoid the potential collapse of the Stormont institutions. I and many hon. Members were glad to see a deal reached and credit the work of all those involved: the parties in Northern Ireland, the Irish Government and many Members of this House.
I have been involved in Northern Ireland affairs for almost 30 years—within the trade union movement, as a member of the Northern Ireland Affairs Committee, and latterly as a vice-chair of the British-Irish Parliamentary Assembly. In the union work in which I was involved in the 1990s, when we worked hard to deliver the peace process, we coined the phrase, “We are a non-partisan agent for change.” It is that phrase that has guided my work inside and outside this House, and it is with that attitude that I want to address the matter before us today.
The Labour party takes great pride in the role it played in bringing about peace in Northern Ireland, working with good people on the ground and around the world on the Good Friday agreement, the “Fresh Start” agreement and much in between. We have always worked in the best interests of the people of Northern Ireland. What is paramount today is ongoing peace and stability in Northern Ireland, and Labour will work with the Government and all interested parties both in this House and in Northern Ireland on maintaining it. I am sure that that sentiment will be echoed by Members in the House today.
The “Fresh Start” agreement included legislative consent from the Northern Ireland Assembly to allow Parliament to enact legislation on its behalf. I respect the legitimacy of the Assembly to do that, but I am sad that it had to. Today’s order seeks to extend, among other measures, the welfare reform Acts of 2012 and 2016 to Northern Ireland. The Government’s welfare reform programme has devastated the lives of far too many vulnerable people across Great Britain, plunging them into financial distress. In the hour before this debate, we heard about the tax credit fiasco. Real people are suffering as a result of measures brought in by this Government over the past six years. I and many other Members from across the country see the effects of the cuts in our constituency surgeries.
This legislation is in the interests of ongoing stability in Northern Ireland, so we will not stand in its way, but the Labour party will never stop showing its ongoing opposition to the Tory austerity agenda, which we have consistently railed against in this House over recent years. We have opposed cuts to tax credits that hit families in the pocket, changes to ESA that hurt those suffering from disease and injury, a benefits caps that does not rise with inflation, cuts to council tax credits, and cuts to crisis loans. We must also never forget that 42% of those deemed fit for work by Atos were actually declared unfit on appeal—a damning indictment of the Conservative party. I could go on and on.
Welfare reform was intended by this Government to impact hard on the UK’s most vulnerable people and to force them to work when they are not well equipped to do so. The desire to inflict on the people of Northern Ireland the same disastrous policy that has blighted the lives of so many of our constituents right across Great Britain is a desperate tactic from a Government more concerned with ideology than compassion. The use of austerity as a weapon of policy was and still is a crude and blunt instrument. The role of austerity in the now hardly mentioned long-term economic plan will be the epitaph of our dear departed friend from Witney and his sidekick from Tatton. Saying “We will make work pay” rings hollow for those forced to look for work while struggling with long-term illness, injury or disease.  The truth is that this Government want to make it impossible for anyone to survive on benefits, which is hugely unfair to those struggling from day to day through no fault of their own.
There may be some who say that the changes should apply to Northern Ireland because they apply across the rest of Great Britain, but, to put it simply, two wrongs do not make a right. The Conservative party clearly believes in the equalisation of misery. Labour believes in the alleviation of misery. When we get back into power, we will not be attacking the sick, the young, the elderly and the disabled or calling them scroungers and skivers. We will not be declaring war on anyone whose curtains are not open by a specific time every day. We will not be making the poor pay for the failings of the rich and those who dabble in money markets. It is interesting that the “Fresh Start” agreement includes measures to mitigate the ongoing austerity regime. While I welcome such measures, does that not show that these changes should not be made in the first place? It is accepted that problems are going to be piled on people who do not deserve them.
We have been advised that the cuts will take £750 million out of the Northern Ireland economy and that the loss per working age adult, at £650 per year, is 38% higher than the UK average. In Northern Ireland, it was recently announced that the Michelin factory in Ballymena will close, resulting in the loss of 860 jobs, that another 250 jobs will be cut in the Caterpillar factory in Newtownabbey and that there will be job losses at Bombardier. Those men and women will find less support than ever and this order will do nothing but compound their difficulties as they try to find their way through the world of unemployment.
As the Minister mentioned, Northern Ireland has some of the highest levels of long-term unemployment in the United Kingdom. Almost one in 10 adults of working age is in receipt of disability living allowance—almost twice the national average—and so will be hit more than those in other parts of the UK. Belfast will be damaged most by the reforms. Poverty is a genuine everyday reality for many in Northern Ireland, and the reforms will serve no purpose other than to compound such difficulties. The cuts will hurt the vulnerable. They hit the disabled, families and children and Labour cannot be complicit in that.
We have to accept that despite the huge opposition to these so called reforms, they have been enforced on the people of Great Britain. But that does not make them any more palatable and it does not give any more reason also to force the changes on the people of Northern Ireland. We have to accept the very real circumstances of its history and of the current difficulties the people of Northern Ireland face. According to figures from the Northern Ireland Statistics and Research Agency, since 1998 more people have taken their own life in Northern Ireland than died throughout the troubles, with research showing that during the recession those figures increased. The suicide rate in Northern Ireland is 70% higher than the UK average. Forcing the vulnerable in society further into despair will do nothing to defeat this problem.
We support any work aimed at maintaining the long-term stability of the institutions in Northern Ireland, as those of us who remember the days of direct rule can attest; we will say how important it is to make sure that  these institutions not only carry on, but flourish and improve. On that basis, we will not oppose this order today, but that should in no way be taken as our condoning what is being done by this Government to the people of Northern Ireland.

Margaret Ritchie: I thank the hon. Member for Blaydon (Mr Anderson) for outlining the position on welfare reform and the fact that it can be so pernicious in bringing about bad impacts on people already on a low income. I welcome the fact that the Minister for Employment is here today, as he has previously been in the Treasury. He has outlined this supplementary legislation.
My party has always been clear about our position, which is on the record both in this Chamber and in the Northern Ireland Assembly: legislation dealing with welfare reform should have been dealt with in the Assembly, as originally envisaged. Westminster’s interference in our devolved welfare arrangements was inappropriate, as were the subsequent fines. As a former Minister for Social Development in Northern Ireland for three years, I recall bringing forward karaoke legislation on welfare issues. Why should it have been different this time?
The Democratic Unionist party and Sinn Féin voted through the legislative consent motion in the Assembly to hand our welfare powers over to Westminster. Indeed, far from its original promises that no claimant would be worse off, Sinn Féin handed our welfare powers over to London to carry out its dirty work, while its Members do not even take their seats in this Chamber. The essence of devolution is to improve the lives of people in Northern Ireland, and devolution is damaged if the two largest parties in the Assembly and the Northern Ireland Executive pick and choose which powers they have and when they have them. People in Northern Ireland must be able to have confidence that the political institutions upon which we agreed in the referendum in May 1998, and the people and politicians involved, are serious about the powers they have and will fiercely defend any attempts to reduce them.
This legislation should have been a matter for the devolved Assembly, which should have resisted the Treasury’s interference and taxes on our devolved budget. Instead, the DUP and Sinn Féin were delighted to have the powers taken off their hands for some 13 months. My party made numerous attempts to build consensus on welfare reform as far back as 2010, both in the Assembly and in this House through my hon. Friend the Member for Foyle (Mark Durkan). He made those attempts when the original Welfare Reform Bill was going through the House—even before the issue came to the Assembly.
The Social Democratic and Labour party was always realistic about the implications of welfare reform and made the case for mitigation that was sustainable and would be included in the devolved budget. I can well recall a meeting we had with Lord Freud, then a Minister in the Department for Work and Pensions, where we outlined specific measures that would help to mitigate the impact of welfare reform in Northern Ireland. Surprisingly—or perhaps not so surprisingly—those mitigation measures areas were eventually to come about. We divided on the Bill last year and on the order when it came to this House in 2015.
I would welcome clarification from the Minister on another matter that is directly related to this order. My hon. Friend the Member for Foyle raised it last week. Clause 9 of the Finance Bill provides for the Treasury to ensure that
“no liability to income tax arises on supplementary welfare payments of a specified description”.
But it also makes provision for the Treasury to make regulations to
“impose a charge to income tax under Part 10 of ITEPA 2003 on payments of a specified description.”
The SDLP has been at the forefront of securing mitigating powers for the Assembly to enable it to make supplementary payments. Can the Minister confirm today that the clause does not give the Treasury the green light to interfere in decisions by the Executive and the Assembly on supplementary payments by dictating that those payments could be subject to a tax clawback? As he knows, such top-up welfare payments will be made from the Executive’s own devolved budget and will not come under annually managed expenditure, which is the usual route for the payment of benefits throughout Northern Ireland. In response to my hon. Friend the Member for Foyle, the Financial Secretary to the Treasury confirmed last week that the clause will not allow that. Can the Minister for Employment reconfirm that position?
As I said, the SDLP has worked to secure mitigation, and the passing of this order will be necessary to release the moneys for mitigation measures or supplementary payments, which we do not want to obstruct. For that reason, we will not push the House to a vain Division on the order today—I am sure some people will be pleased about that. Notwithstanding that, it is important to remember that welfare reform, and particularly the legislation upon which this order is based, will introduce pernicious measures into Northern Ireland and will have an impact on those with low income who are reliant on benefit. I fear that it could push people further into poverty. It is therefore incumbent on the Government to ensure that people are protected and that there is some form of cushion for them. I respect the fact that the mitigation measures will ensure that there is, but the Government must consider other measures to ensure that people can live decent lives.
Earlier today, the hon. Member for Belfast East (Gavin Robinson) initiated a debate on social fund funeral payments. The SDLP participated in that debate, because there is a feeling that those payments have been capped for several years and there has been no corresponding increase when the costs have exceeded the bounds of many people’s income. The Minister responding to that debate did not give us a helpful response about future DWP or Treasury measures to increase such payments. When we discuss welfare matters in relation to Northern Ireland, it is important that we take into account the special circumstances of the many people, particularly in urban areas, who find themselves unemployed, perhaps through no fault of their own, and are in receipt of benefits. They must have a financial cushion and protection in order to live their life without any detriment.

Sammy Wilson: The fact that this order has been brought before the House today indicates the radical steps that had to be taken to rescue  the Northern Ireland Assembly from financial and political collapse. Let us be in no doubt about this: the Northern Ireland Assembly faced that collapse because of the attitude of those who, despite all the protestations that legislation on matters devolved to Northern Ireland should be dealt with by the Northern Ireland Assembly, took a totally irresponsible view and blocked the Assembly’s ability to make decisions. That plunged the Assembly into financial crisis.
It is less than a year ago that the welfare reform legislation went through the House of Commons. Although the matter had been devolved to Northern Ireland, it was always assumed that the legislation passed in this place would be reflected in the legislation passed in Northern Ireland. The bill was being paid through the AME payments that came to the Northern Ireland economy—in other words, it was money that was paid on demand. If unemployment went up, we did not have to find the money from the block grant; it came centrally from the Exchequer. If there was a change in the number of claimants for a benefit, the money was automatically made available.
Of course, there was opposition to some of the welfare reform measures—indeed, my party voted against a number of them—but once they had been through the House of Commons, the stark choice for the Assembly was between deviating from those measures and paying for the deviation, and complying with them and ensuring that payments to the Northern Ireland expenditure block continued. There were some who, because of their minority position in the Assembly—the SDLP led the charge—wanted to have it both ways. They wanted to ensure that the budget in Northern Ireland was not put into jeopardy, but at the same time, like Pontius Pilate, they wanted to wash their hands of what was happening and say, “By the way, the consequences of welfare reform are nothing to do with us, because we voted against it. It was all those other parties that voted it through.” That was the position that we faced because of the political structures in Northern Ireland.

Gavin Robinson: The hon. Member for South Down (Ms Ritchie) suggested that attempts were made to reach consensus with other parties in Northern Ireland. Can my hon. Friend recall any proposal that was made to build consensus and overcome the significant hurdle that he has just outlined, which was that we could either deviate from the welfare reform measures or follow them?

Sammy Wilson: That was the problem. In his short intervention, my hon. Friend did not have the opportunity to explain what happened. We were not delighted that the powers were taken away from us, but because of the use of the petition of concern by the SDLP and others, the ability to bring legislation forward was blocked. We then faced a situation in which we could not bring forward our own bespoke Northern Ireland legislation because of the block.

Margaret Ritchie: rose—

Sammy Wilson: I will give way in a moment, but let me just explain this, because it is important. Rather than being delighted that Westminster had taken responsibility, our party worked frantically to try to find ways of ensuring that the worst aspects of welfare reform—the ones that we believed were the most damaging and that, for structural reasons, could not be introduced  in Northern Ireland—were dealt with by taking money from other priority areas. We used that money to alleviate some of the difficulties. That was blocked—stopped dead in its tracks—by the SDLP’s use of the petition of concern. We worked our socks off to try to get a bespoke arrangement for Northern Ireland, which could be agreed to by all of the parties and would therefore have some kind of democratic authority, but it was impossible to do that because of the actions of the SDLP. It protested that it wanted the legislation dealt with in Northern Ireland, but did its darnedest to ensure that it could not be dealt with in Northern Ireland and that it had to be dealt with here.

Margaret Ritchie: Let me refresh the hon. Gentleman’s memory, as I fear that he and his colleagues may have forgotten what actually happened. My colleagues in the Northern Ireland Assembly proposed an all-party Committee as far back—[Interruption.] It is not flannel. It was proposed as far back as March and April 2011 to address this issue. We wanted to achieve all-party consensus so that we could go forward to the Treasury here in London as a united team to achieve the best possible deal for the people of Northern Ireland.

Sammy Wilson: I was the Finance Minister in Northern Ireland at the time, and I can remember those discussions. There was a whole list of demands. Basically, it was demanded that we should not introduce any of the welfare reform proposals and that we should just go ahead as usual. The important question was who was going to pay for it. There was a naive belief that if all the parties in Northern Ireland came to Ministers here in London, with them the great and the good from Northern Ireland on their coat-tails, and pleaded a special case, we would somehow be exempt from the welfare changes that were being made in all other parts of the United Kingdom. That was the cunning plan. I am afraid that even those who were sympathetic to the SDLP’s point of view knew that nothing would come from it. Indeed, Baldrick could not have devised a more stupid plan had he sought to do so.
There is no point in saying that the SDLP tried to find ways of changing this; the only suggestion was that we should oppose the changes and say that we therefore did not want them for Northern Ireland. The more realistic position, and the one now reflected in the order, was to say that we should look at what resources were available, look at the most damaging aspects of the legislation and see whether we could find, within our own resources, the ability to mitigate some of them.
Over the term of this Assembly, we will find from our own resources—that means reducing the priority in some areas—a way to protect the most vulnerable. We will mitigate the measures by, for example, not enacting the spare room subsidy, or by compensating people for it. We may also use the work allowance and a range of other things. We will find half a billion pounds over the lifetime of the current Assembly to alleviate some of the impacts of the welfare reform changes, and those are reflected in the legislation that is before the House today.
It is a great pity that there was not the maturity to have those changes made through legislation that was debated and passed in the Northern Ireland Assembly.  At the “Fresh Start” talks this time last year, or just later, it was agreed that, rather than going through the process of trying to force this issue through the Assembly when we knew the blocking mechanism would be employed again by the SDLP and some of its allies, it would have to be dealt with here in the House of Commons, and that is the position we are in today.
Let me just emphasise a number of points. First, there are welfare changes that we supported here in the House of Commons because we believed that welfare did need reform. Secondly, we believe that any welfare system ought not to be designed in a way to dissuade people from wanting to look for work—that is important. Therefore, we did support some of the changes, even in the debates here in the House of Commons. Thirdly, there were things that we did not support, but once they got through the House of Commons, and we knew we could not afford them in Northern Ireland, we accepted that they should be part of the legislation. Fourthly, there were things that we believed we could change and that we could find the money to change, with bespoke legislation for Northern Ireland, and those things are reflected in the proposal we have before us.
The last point is, of course, that this will all be devolved back to Northern Ireland at the end of this year. I trust that we will have learned from the debacle that brought the Assembly and politics into disrepute, and that we will learn that, sometimes, there are hard choices to be made and that we should at least be prepared to face up to those hard choices and find ways of dealing with the consequences of legislation that comes from this place.

Alasdair McDonnell: Will the hon. Gentleman not honestly accept that, really, the whole debacle was more about him and his party not wanting to troop through the Lobby in a love-in with Sinn Féin to inflict poverty on people in Northern Ireland?

Sammy Wilson: This is the amazing thing: I know there are all these attempts to rewrite history, but it was a DUP Minister who actually brought the legislation to the Assembly—who was prepared to walk through the Lobby and to vote for it. However, because a petition of concern was introduced by the SDLP, even if a majority of Members in the Assembly had voted for the legislation, it would still not have become law. Once that petition of concern was triggered and the legislation was turned down, we were in a position where we could not have any welfare reform Bill. That is the truth of the matter—not that we ran away. We faced up to things. I can remember doing interview after interview where we even faced flak from people who said, “You’re going to hurt individuals because of part of this legislation.” We argued, “At least we’ve done something to mitigate it. We have got the best possible deal.”
Can I just say that we did get changes and allowances made by the Department for Work and Pensions? I want to give credit to Ministers in the Department. When we were negotiating on welfare reform, they accepted that Northern Ireland could make changes, albeit that we had to accept the financial consequences of those changes. However, flexibility was demonstrated by the Department, although it was rejected by those who wanted simply to be able to say, “We are purer than everyone else on this issue. We have stood on our principles”—regardless of the consequences of that.
We have the legislation that we have today. Those who are most vulnerable in Northern Ireland have been safeguarded by the changes that have been made and by the resources that have been devoted to this issue by the Northern Island Assembly, and that has been a painful choice, because, of course, it means that there is less money to spend on other things.

Margaret Ritchie: Will the hon. Gentleman give way?

Sammy Wilson: The hon. Lady had plenty of opportunity to make her point during the debate, and I have allowed three or four interventions already—I know she is struggling with the case that she has and with the embarrassment of the way in which the SDLP has handled this issue.
We now have this piece of legislation. I recommend it to the House—it is the best deal we could possibly have got. Unfortunately, it would have been far, far better had it gone through the Assembly, but because of the Assembly’s structures and the ability of minority parties to obstruct legislation through a petition of concern, this measure was the only avenue by which we could ensure that the Assembly finances were protected and that the political process in Northern Ireland was able to continue.

Tom Elliott: I may come later in my short speech to a few of the points that the hon. Member for East Antrim (Sammy Wilson) raised. First, however, on the detail of the legislation, I want to make it clear that the Ulster Unionist party supports the benefit cap, for example, because it is important that we keep people in work. People are better off in work than totally relying on benefits, so we do support a raft of these issues.
We are still concerned that the split cap level between London, where it is £23,000, and the rest of the UK, where it is £20,000, represents the most significant non-conformity in the UK’s social security system. It will need to be watched closely, and the issue is obviously with the reserved Government here at the moment. Clearly, that is where the watching brief must be, and I am sure that the Northern Ireland Assembly and Executive will also make representations here.
It had originally been planned to introduce universal credit in Northern Ireland from 2017, but that has now moved to the autumn because the development work on the Northern Ireland changes to the universal credit information and communications technology system has been delayed. The deadline still remains June 2018. As such, the Department for Communities in Northern Ireland has now found itself with the unenviable task of trying to implement one of the biggest shake-ups in a generation over less than 12 months, but I am sure it will manage that with the help of others.
We still do not support the abolition of the work-related activity component of employment and support allowance for new claimants from April 2017. However, the debate has been held, and the Government have not taken that on board, so we must progress with what we have. We must now move on to identify all the additional support and help that claimants need to help them return to work.
On a more principled issue, there is huge frustration that, first, this measure has had to come back here to be implemented and, secondly, that it has taken so long, at  a huge cost to organisations such as the health service and the education service, where there have been delays after delays. A lot of this has just been grandstanding. I fully accept the point that some people just did not want to vote for this in the Northern Ireland Assembly and Executive. Let us be blunt about it: Sinn Féin was the biggest proponent of that, assisted to some extent by the SDLP. The reality is that this issue could have been resolved many months—in fact, years—ago. The delays have been at a huge cost to the people of Northern Ireland—the ordinary people who needed that health care and that education.
I support the continuance of this measure. There are some changes that I would have liked to see that did not happen, but we are where we are, so I support the progression of this measure. Clearly, however, we cannot get into another mess like the one we have been in for the last couple of years; otherwise, the Northern Ireland Executive and Assembly will be back to a very difficult position and, once again, to stalemate.

Nigel Dodds: It is a pleasure to follow the hon. Member for Fermanagh and South Tyrone (Tom Elliott). I want to support what my hon. Friend the Member for East Antrim (Sammy Wilson) said very powerfully about why we are here today debating this statutory instrument. It is important to emphasise that this is not a situation that we on these Benches wanted to see. We want to see the Northern Ireland Assembly legislate in those areas that are devolved, although it should be noted that the Scottish Parliament, with the extensive powers it has, does not have responsibility for welfare. This is an area where Northern Ireland took responsibility, and those who negotiated the 1998 Belfast agreement decided it would be a good idea to devolve welfare to Northern Ireland, with the massive cost that comes with that, although the vast bulk of it, as my hon. Friend said, comes from direct payments and not out of the Northern Ireland block grant. As a former social development Minister back when devolution began in 1999, I remind the House that the understanding was that there should be parity, because if we deviated from that, then Northern Ireland would have to pay for it out of the block grant. Areas such as hospital spending, education, the environment and housing would all have to suffer cuts to pay for any deviation.
This comes to the crux of the arguments that took place in the Northern Ireland Assembly in recent times. People in certain parties—notably the SDLP, and at times Sinn Féin and others—would say, “Let’s deviate, let’s do our own thing—we’re not accepting these welfare cuts.” Their proposal to try to get something for Northern Ireland was to say, “Let’s set up a committee, go and knock on the door of the Treasury, and demand that Northern Ireland receives hundreds of millions of pounds extra,” which was never going to happen.
Had this measure not been introduced—had the “Fresh Start” negotiations that took place primarily between the DUP and Sinn Féin not had a successful outcome—then by now we would have had full, untrammelled direct rule from this place. That is the reality of it. We would have had welfare changes in Northern Ireland that were exactly the same as those in England and Wales. There would have been none of the mitigations—none of the changes that we implemented, and wanted to see  implemented. So the consequence of the approach of members of the SDLP and others who opposed a sensible compromise would have been full, untrammelled welfare changes of the sort that they say they oppose.

Tom Elliott: Can the right hon. Gentleman enlighten us, because I have not got to the bottom of this, on why Sinn Féin has done such a somersault on this? It totally opposed it for years, and then all of a sudden it seemed to come to its senses and accept the principle of it. Can he shed any light on that?

Nigel Dodds: It is for Sinn Féin to explain its own position. It is not for me to speak for it, especially when its Members do not come to this House. Certain Members are often seen about the corridors. They are here to collect their allowances—their political representation money and their constituency office allowances—but that is all they do; they do not take part in any other parliamentary processes. I will therefore leave it to them.
The reality had to dawn on people in Northern Ireland that we were facing the collapse of the political institutions. It is a bit like a local council in England or Wales, or anywhere else, being told, “Here’s your financial settlement—here’s what you’ve got to work within,” and the leading party there saying, “Sorry, we’re not going to accept that. We’re going to set budgets that are way beyond that, we’re going to just ignore the financial realities, we’re not going to make any compromises which will safeguard the most vulnerable”—

Margaret Ritchie: Will the right hon. Gentleman give way?

Nigel Dodds: No. The hon. Lady had plenty of time to put her arguments to the House, and the fact that she was unable to put any convincing arguments is her responsibility.
In terms of financial responsibility, serious parties of government—parties that are serious about running countries and being in government—have to take difficult decisions within the financial parameters that they are set, especially in a devolved Government. If we simply say, “We’re not going to do that—we demand that you give us more,” it eventually leads to collapse.
Let us remember that the people of Northern Ireland had their say—

Margaret Ritchie: Will the right hon. Gentleman give way?

Nigel Dodds: No, no—the hon. Lady has had her opportunity to speak, and I am not giving way.
The people of Northern Ireland have had their say. There was an election in May in which they delivered their verdict on the whole social security debacle and on how the DUP and other parties had performed. The SDLP and certain other parties had their worst ever result in Assembly elections. The DUP was returned with one of its best results ever and is back at the head of Government in Northern Ireland. The people of Northern Ireland saw very clearly what was going on. They recognised that parties and politicians have to face up to their responsibilities. If they are not serious about that, they will be rejected at the polls.
I, too, welcome this legislation. I wish the DWP Minister, who has moved from the Treasury, well in his work. I hope that we come to a point where we do not need such legislation to come to the Floor of the House of Commons and can get back to dealing with it in the Northern Ireland Assembly.

Damian Hinds: Let me emphasise that this order fulfils a vital commitment made as part of the “Fresh Start” agreement. We have had a robust debate on some of the historical aspects of how we got to this point. In the interests of time, I think it best that I do not reflect further on that. Suffice it to say that the two largest parties in the Assembly signed up to the “Fresh Start” agreement of which this legislation was a crucial part. Moreover, the Assembly passed a legislative consent motion supporting the legislation to be dealt with here in Westminster. As the right hon. Member for Belfast North (Mr Dodds) said, Northern Ireland has long kept to parity on social security, as set out in section 87 of the Northern Ireland Act 1998. Restoring that parity is a crucial part of keeping the Executive’s finances stable. The provisions on the welfare supplementary payments will be put forward in full detail by the Executive and the Assembly.
In response to the question about taxation from the hon. Member for South Down (Ms Ritchie), supplementary payments to non-taxable benefits will be non-taxable, and supplementary payments to taxable benefits will be taxable, so the tax treatment will be the same as in the current system.
This order is a crucial part of delivering the “Fresh Start” agreement. It will help to build a politically and financially stable Northern Ireland. I commend it to the House.
Question put and agreed to.
Resolved,
That the draft Welfare Reform and Work (Northern Ireland) Order 2016, which was laid before this House on 6 July, be approved.

Social Security

Richard Harrington: I beg to move,
That the draft Pensions Act 2014 (Consequential Amendments) Order 2016, which was laid before this House on 4 July, be approved.
This order implements a small number of further minor consequential amendments in connection with the introduction of the new state pension. It does two things. First, it ensures that existing administrative arrangements that are designed to facilitate the annual uprating exercise will continue to operate as they do now. Secondly, it gives appeal rights to decisions about national insurance credits that count for new state pension purposes.
Let me deal first with the amendments to do with uprating. Article 2 amends the Social Security Administration Act 1992, which deals with alterations in the payable amount of certain income-related benefits due to uprating: that is, income support, income-based jobseeker’s allowance, income-related employment and support allowance, universal credit, and pension credit. These provisions allow an existing award of these benefits to be altered automatically to take account of the uprating of another benefit in payment to the claimant or their partner, without the need for a further decision by a decision maker. They can also enable the decision maker to take account of the new rates from the uprating date when he or she is determining a new award that begins before the uprating order has come into force, rather than having to revisit the award to apply the new rates at a later date. Article 2 retains long-standing administrative easements that support the annual uprating exercise. It is simply a case of delivering business as usual in a case where a person or their partner’s benefit income is the new state pension. These amendments will therefore apply for the first time in April 2017, with the first uprating exercise for the new state pension.
I turn to the amendment to do with appeal rights for national insurance credits. Article 3 amends schedule 3 to the Social Security Act 1998, which lists decisions that carry the right of appeal. This schedule already includes decisions on credits awarded under the old 1975 credits regulations, and also needs to include those provided for under part 8 of the new State Pension Regulations 2015. The policy intention is that decisions made in relation to those credits should carry the right of appeal. That should have been enacted with effect from 6 April 2016, but I regret to say that it was overlooked and that, as the law stands, they do not have that right. The amendment makes good that omission and it will come into force on the day after the order is made.
Of course, that means that there will be a period in which decisions will be made that were intended to carry the right of appeal but that cannot in law be appealed. Those decisions are made by Her Majesty’s Revenue and Customs officials on behalf of the Secretary of State for Work and Pensions, so my officials have been working very closely with HMRC to find a solution.
That solution involves a workaround. Once the order comes into force, any decisions made under the provisions in part 8 of the State Pension Regulations 2015 will be appealable. HMRC will revisit any decisions made before  the order comes into force, and when fresh decisions are made they will carry an appeal right. There will be no substantial difference in outcome between an original decision, had it been appealable and successfully appealed, and a fresh decision that is successfully appealed. A successful appellant will have credits awarded to them.
Importantly, I reassure the House that, to date, no one has in practice been affected. That may seem unlikely at first glance, but there are a number of reasons for it. First, the omission can affect only certain decisions made since 6 April 2016. Secondly, it affects only credits for which a person has to apply.
The practical impact of this gap in the law relates only to decisions about credit that a person has applied for since 6 April 2016. They include new credits that cover past periods in which a person was accompanying their armed forces spouse or civil partner on an overseas posting. Ordinarily, credits awarded for the tax year 2016-17 would be taken into account only in the assessment of new state pension awards that will be made after 6 April 2017. However, those new credits could affect state pension awards made since 6 April 2016.
A further mitigation is that, before a person can lodge an appeal, they have to ask for the decision to be reconsidered by a decision maker—a process known as mandatory reconsideration. Mandatory reconsideration enables a decision maker to reconsider the decision and the facts taken into account in making it. If, on reflection, it is considered that the decision should be changed, it can be revised without the claimant having to go through the whole appeal process. HMRC data from the last tax year, 2015-16, tell us that fewer than 10 cases where a credits decision under the 1975 regulations was disputed ended up progressing to appeal.
Finally, out of 324 applications for the new armed forces partner credits that have been refused up to 5 September, 201 of those refusals were because the tax year being applied for was already a qualifying year for other reasons, so the applicant would not need the credit in order to establish their new state pension entitlement.
It is an unfortunate situation, but I hope that I have reassured the House that, even if a case did materialise, we have measures in place to ensure that, while justice may be delayed, it will not be denied. We are confident that no individual will be disadvantaged by the oversight.
I am sure you will be delighted, Madam Deputy Speaker, that I can confirm that I am satisfied that the instrument is compatible with the European convention on human rights, and I commend the order to the House.

Debbie Abrahams: I warmly thank the Minister for introducing the order. May I also take this opportunity to welcome him to his place? It is nice to see him there.
Although I recognise that the order principally tidies up existing legislation—as such, I will not oppose it—I want to make a few comments about articles 2 and 3, as well as about the decision not to conduct an impact assessment.
Article 2 enables the income-related benefits awarded to recipients to be adjusted to account for additional income being received through an uprating of the new state pension, without requiring Secretary of State oversight,  as the Minister has explained. The arrangement applies to the old state pension and it is now being carried forward to the new one, so it is relatively uncontroversial. However, I want to push the Minister on the specific changes to entitlements for couples.
The explanatory memorandum states that, currently, where one member of a couple has reached a qualifying age for pension credit but the other has not, the couple can choose to claim either pension credit or the relevant working-age benefit. The explanatory memorandum points out that most choose to go for pension credit as, should they choose to access the working-age benefit, they will be subject to conditions that do not apply to pension credit. From 2018, it is planned to remove the option to claim pension credit, replacing it with universal credit for mixed-age couples making new claims.
What are the proposed transitional arrangements to cover those changes? Would someone covered by transitional protections who loses their entitlement to pension credit for a short period then be expected to enrol on universal credit? How do the Government plan to communicate those changes? Given the important differences in the amount awarded under pension credit compared with most other working-age entitlements, as well as the strict conditionality requirements of universal credit, I am sure that the Minister will agree that it is very important to ensure that all those affected are well informed.
Article 3 provides for a right of appeal against a decision as to whether a person is to be credited with earnings or contributions for the purposes of entitlement to the state pension. Under the old state pension, people who reached state pension age before 6 April 2016 already had a right to appeal decisions regarding whether they were eligible for credits. The order, as the Minister has explained, extends that right of appeal to the new state pension.
The explanatory memorandum states that that right should have been in place from 6 April 2016 but that it was “unfortunately overlooked”. That omission is disappointing, not least for those who might have been affected. Although the Minister has taken pains to explain that it has not affected anybody and that there are measures in place to ensure that no one will lose out, I would be grateful if he would write to me to clarify how many people have been denied a claim since 6 April and who might have been affected. For example, were women and people on low incomes more likely to have been affected? I would also be grateful if he could confirm in writing how the situation for all those who have had applications for credits declined will be resolved?
I want briefly to touch on the related issue of take-up of national insurance credits. NI credits cover circumstances in which people are not working, and in some cases they require an application to be made. In 2013, the Government acknowledged that there was a low level of awareness and understanding of some NI credits, such as carer’s credit. They said that the low take-up rate suggested that the credits were
“not achieving their stated aim of protecting the state pension position of individuals who take time out of paid employment due to caring responsibilities”.
Of course, in many cases, those affected are women.
The Government undertook to review the system, develop a customer-focused communications strategy and work with outside agencies to encourage take-up. They said that state pension statements, which individuals have to request, would be the vehicle for providing individuals with personalised information about their entitlement. In last week’s debate on this order in the other place, the Minister for Welfare Reform said:
“There are around 400,000 eligible for carer’s credit and, in August, there were 10,900 recipients.”—[Official Report, House of Lords, 8 September 2016; Vol. 774, c. 1221.]
According to my maths, that is about one in 40, which means that a very low proportion of those who are eligible to apply have received entitlements. Do the Government have plans to review their approach and to look again at some of the recommendations made by the Work and Pensions Committee in its report, “Communication of the new state pension”?
Finally, I want to push the Minister on the decision not to undertake an impact assessment when preparing the order. The Government argue that the order has no impact on civil organisations or the private sector. Is this not a narrow interpretation of when an impact assessment should be carried out? Can the Minister reassure the Opposition that a dangerous precedent is not being set? As we know, impact assessments by this Government have tended to be rather inadequate.

Ian Blackford: I welcome the Minister to his place. It is a pleasure to see him here. We on the Scottish National party Benches look forward to working with him to the benefit of pensioners when it is appropriate to do so.
We welcome the measure in so far as it enables the award of certain income-related benefits to be adjusted automatically when the new state pension is uprated, but when the measure was drawn up, was consideration given to the results of the EU referendum and the uncertainty that arises for the 400,000 UK pensioners living in EU countries? The House will be aware that long-standing rules enable the co-ordination of social security entitlements for people moving within the EU. One result is that the UK state pensioners resident in EU countries receive annual increases to their UK state pension. Elsewhere, the UK state pension is uprated only if there is a reciprocal social security agreement requiring this.
The Government could have taken the opportunity today with these measures to address the concerns of the 400,000 UK pensioners living in the EU. Why has this not been done? Does the Minister agree that those UK citizens residing in EU countries who are entitled to a UK pension and all annual increments, as would be the case if they were living in the UK, should have those rights protected after the Brexit vote? Can he give an assurance today that this will happen?
In a parliamentary answer on the issue on 8 July the then Minister for Europe, now Leader of the House, said:
“It will be for the next Prime Minister to determine, along with their Cabinet, exactly the right approach to take in negotiating these provisions going forward but the Government’s guiding principle will be ensuring the best possible outcome for the British people.”
Given that the Prime Minister has had time to settle in, there has been ample opportunity to address this question. May we have an answer today and remove this uncertainty for UK pensioners? Prior to our entry into the EU, the UK had bilateral arrangements with a number of European countries. What will be the situation where this was previously the case? Do those arrangements remain in force and can the Minister reassure pensioners in those countries?
The measures before us also fail to address the issue of the 500,000 UK pensioners living in territories where there is no annual uprating. Why are not the Government bringing forward today plans to restore annual uprating to all British pensioners, based on entitlement and regardless of domicile? It is morally unjust and truly unfair for the Government to strip pensioners of their right to equal state pension payments. There are a host of reasons why a pensioner may choose to move abroad in later life, such as wanting to be closer to family or friends, or to enjoy a different lifestyle. It is simply wrong to punish them for making that choice.
Pensioners who have paid the required national insurance contributions during their working lives, in expectation of a decent basic pension in retirement, will find themselves living on incomes that fall in real terms year on year. Payment of national insurance contributions in order to qualify for a state pension is mandatory. All recipients of the British state pension have made these contributions, and although historically the level of pension received has varied according to the level of contributions made, it is clearly unfair to differentiate payment levels by any other criterion.
Pensioners will now face ending their days in poverty because they chose to live in the wrong country, in most cases without any knowledge of the implications of their choice for their pension. Others are forced back to the UK, away from the family they love, just to secure an income on which they can retire. All should receive their full and uprated pension according to their contribution, regardless of where they choose to reside. Reform would bring the UK into line with international norms, as most other developed countries now pay their state pension equivalents in this way. We are the only OECD member that does not do so.
Most pensioners had no idea that their pension would be frozen when they chose to emigrate. The frozen pension policy acts as a disincentive to pensioner emigration. As the International Consortium of British Pensioners put it, people currently living in the UK who would like to emigrate and who are aware of the frozen pension policy know they would not be able to afford to live on a state pension at its current level in their older years, by which time inflation will have decreased its value, and accordingly they decide not to move.
There is a real disparity in the treatment of UK pensioners and no consistency in how overseas British pensioners are treated. Those who live in the US Virgin Islands get a full UK state pension; those who live in the British Virgin Islands do not. Overseas pensioners are entitled to fairness. The state pension is, after all, a right, not a privilege. It is not a benefit; it is an entitlement to a pension based on paying national insurance contributions.
Given that the measures before us are provisions that support the annual exercise to uprate social security benefits in payment, will the Minister clarify the Government’s position on the triple lock? There have  been suggestions that the triple lock may not survive. We on the SNP Benches fully support the continuation of the triple lock. It is the right thing to do to protect the interests of our pensioners. Will the Minister join me in championing the triple lock and commit the Government to continuing with it?
As we are talking about pensioners rights, equity and fairness, can the Minister tell us why, when we are discussing the state pension, there is no mention of the WASPI—Women against State Pension Inequality—women and no solution to the injustices that many face in this secondary legislation package? It is not right that women born after 1953 are having to wait so much longer than those born in previous years to collect their state pension. The Government will have to bring forward mitigation to deal with these injustices, and do so quickly. Why are there no measures in this package to deal with those issues?

Richard Harrington: I am grateful to the hon. Members for Oldham East and Saddleworth (Debbie Abrahams) and for Ross, Skye and Lochaber (Ian Blackford) for their contributions to the debate and for their kind words, which I appreciate. I am sure this will be the first of many occasions when we take part in such debates.
Let me deal briefly with the points that the hon. Gentleman made. I am aware that he has spoken many times on the frozen pensions issue, but the policy on that is unchanged. It has been in place for almost 70 years, under all sorts of Governments, and there are no plans to change it. The Government comply with their legal obligations where reciprocal agreements exist with other countries. There are no plans to change that and I would not like to mislead the hon. Gentleman by saying that there are.
On the triple lock, I will happily send the hon. Gentleman a copy of the Conservative party manifesto, if he is interested. I am sure it is still available from all good bookshops, and probably some bad bookshops as well. The Government are committed to retaining the triple lock throughout this Parliament. They have said so several times in the past and I am happy to repeat it for him.
The hon. Lady commented on the statutory instrument. On the transitional arrangements—for example, on ending the choice for mixed-age couples—the choice is ending because it is not right that a working-age customer should be exempt from any work-related conditionality just because they have a pension-age partner. Couples in receipt of pension credit at the date that the change is introduced will continue to be eligible for pension credit unless entitlement ends for some other reason—some change in their circumstances.
The hon. Lady asked me if I could indicate the number of claimants to date who had been denied a right of appeal as a result of the omission that we have mentioned. I will check and, if necessary, respond to her in writing. To my knowledge, we do not hold that information because administrative data are not routinely collected by HMRC on volumes of all clerically administered credit applications, but I am happy to get back to her on that point.
Very briefly—hon. and right hon. Members have had a lot of patience with this statutory instrument—the credits affected include applications predominantly for  spouses and civil partners of members of the armed forces, as the hon. Lady said, but also for partners of recipients of child benefit where entitlement to the credit is transferred to the applicant, for people providing care for a child under the age of 12—that is called grandparent credit—for being a foster parent and for persons approaching pensionable age.
I have explained what the order covers and these consequential amendments, and we have been through them both in quite some detail. We have acknowledged the gap in the law. This is the first time we have dealt with that gap in the law, but we have put mechanisms in place to make sure that no one is disadvantaged. Fortunately, we have not yet needed to employ them because no one has sought to appeal.
I hope I have provided the clarification that the hon. Members required, but I am very happy to speak to them separately, should they require further clarification. I commend this order to the House.
Question put and agreed to.

Natascha Engel: We now come to motion 4 on local government. I remind the House that as the Speaker has certified that this instrument relates exclusively to England and is within devolved legislative competence, this motion is subject to double majority. If a Division is called, all Members of the House are able to vote in the Division. Under Standing Order No. 83Q, the motion will be agreed only if, of those voting, both a majority of all Members and a majority of Members representing constituencies in England vote in support of the motion. At the end, the Tellers will report the results, first, for all Members and, secondly, for those representing constituencies in England.

BUSINESS WITHOUT DEBATE

Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Local Government

That the draft West Midlands Combined Authority (Election of Mayor) Order 2016, which was laid before this House on 30 June, be approved.—(Andrew Percy.)
The House divided:
Ayes 290, Noes 3.
Votes cast by Members for constituencies in England:Ayes 271, Noes 3.

Question accordingly agreed to.

OPPOSITION DAY - [UN-ALLOTTED HALF DAY]

NHS SUSTAINABILITY AND TRANSFORMATION PLANS

Diane Abbott: I beg to move,
That this House notes with concern that NHS Sustainability and Transformation Plans are expected to lead to significant cuts or changes to frontline services; believes that the process agreed by the Government in December 2015 lacks transparency and the timeline announced by NHS England is insufficient to finalise such a major restructure of the NHS; further believes that the timetable does not allow for adequate public or Parliamentary engagement in the formulation of the plans; and calls on the Government to publish the Plans and to provide an adequate consultation period for the public and practitioners to respond.
I am glad to open this debate on the NHS sustainability and transformation plans. As the whole House knows, the NHS has a special place in the affections of our constituents. No other public service engages with us all when we are at our most vulnerable—in birth, death and illness—and the public and NHS staff are increasingly aware that the NHS is under severe financial pressure, a matter I will return to.
In that context of financial pressure and concern about the availability of services, the sustainability and transformation plans are arousing concern. They sound anodyne and managerial, and there is undoubtedly a case for bringing health and social care stakeholders together to improve planning and co-ordination. But the concern is that, in reality, the plans will be used to force through cuts and close hospitals, will make it harder for patients to access face-to-face consultations with their GPs, and, above all, will open the door to more privatisation. It tells the public how little the Secretary of State cares about their concerns that he is not in the Chamber to listen or respond to this debate. We know that recently he has missed all seven recent meetings of the NHS board. The public are entitled to ask how much he cares about their very real concerns.

Helen Whately: The hon. Lady mentioned cuts, but this Government are putting more money into the national health service—an extra £10 billion a year. The Labour party had no intention of making that sort of financial commitment to the NHS, as we saw in its failure to do so before the last election.

Diane Abbott: The NHS was never better funded than under the last Labour Government and the public know that. That is why they trust us with the NHS.

Andrew Murrison: Will the hon. Lady give way?

Diane Abbott: I need to make progress.

Steve McCabe: Will my hon. Friend give way?

Diane Abbott: Yes.

Ah!

Lindsay Hoyle: Order. I think we can spot that the hon. Lady has just given way to a Government Member and now she is giving way to an Opposition Member. We do not need the cheering to go with it.

Steve McCabe: I want to check this with my hon. Friend. The last time I checked, Simon Stevens had said that STPs were designed to make up the £22 billion shortfall that the Government are not prepared to put in. Is that not the case?

Diane Abbott: It is indeed the case; rather than being an anodyne managerial exercise, the sustainability and transformation plans are designed to make up the missing £22 billion.
One of the most alarming aspects of the STPs is their secrecy. England has been divided into 44 regional footprints, and it is worth noting that they are called footprints to distract from the fact that they are ad hoc regional structures—they are the exact same regional structures that the Tory health Bill was supposed to sweep away. Because they are ad hoc and non-statutory, they are wholly unaccountable. In the world of the STPs, the public have no right to know.

Simon Burns: Will the hon. Lady give way?

Maria Eagle: Will my hon. Friend give way?

Diane Abbott: I give way to my hon. Friend.

Maria Eagle: I am grateful to my hon. Friend for giving way. We have a leak of the STP for Merseyside and Cheshire, which states that there is an “appetite for hospital re-configuration” because the existing set-up is “currently unaffordable”. Given that it also says that almost a £1 billion gap is to be expected by 2021, and that the public have not yet been consulted, does my hon. Friend agree that when the public are consulted, there will be an absolute outcry?

Diane Abbott: That is the reason for the secrecy thus far. The Government know that if the public understood what STPs meant, there would be an outcry.

Norman Lamb: Does the hon. Lady agree that unless the local community are fully engaged in the process of considering how the health and care system needs to change their area, the process is destined to fail and simply will not work?

Diane Abbott: I am grateful to the right hon. Gentleman. For nearly the whole time I have been in Parliament, there have been attempts to reconfigure hospitals and close A&Es and make other changes in London. We have found that when the local community does not take ownership of the plans, it is impossible to take them forward. That secrecy runs counter to making the reorganisations we might have to make.

Simon Burns: Will the hon. Lady give way?

Diane Abbott: Initially, the STPs were discouraged from publishing their draft plans, freedom of information requests were met with blank replies, and enquirers   were told that no minutes of STP board meetings existed. We are therefore bound to ask: if the plans are really in the interests of patients and the public, why has everyone been so anxious to ensure that patients and the public know as little as possible?

Simon Burns: Will the hon. Lady give way?

Diane Abbott: In some cases, even local GPs have not been fully involved in decision making. Hon. Members may not take that seriously, but I assure them that their constituents will. [Interruption.]

Lindsay Hoyle: Order. Can I just suggest that it is up to the hon. Lady whether she wishes to give way or not? Shouting and screaming will not help with the debate because Members on both sides want to hear. I am sure that, when she wants to give way, she will do so, but screaming will not help, and it certainly does not help my ears.

Diane Abbott: GP leaders in Birmingham said that it would appear that plans by the STP to transform general practice, and to transform massive amounts of secondary care work into general practice, are already far advanced. Only at this late stage have they been shared with GP provider representatives.

Alex Cunningham: Freedom of information requests have also uncovered the substantial role of the private sector in formulating these plans. GE Healthcare Finnamore, for example, is advising STPs across the south-west, and I have no doubt that work is under way for it to get larger slices of the action in the future. In the name of transparency, does my hon. Friend agree that all their boards should publish everybody who is on them, with their declared interests as well?

Diane Abbott: I entirely agree with my hon. Friend. All STPs should publish who is on them, what their financial interests are, and how far advanced they are in planning. However, thanks to the work of organisations such as Open Democracy and 38 Degrees—and, frankly, thanks to leaks—the picture of what STPs will mean is becoming clearer.
We know from the information we have been able to glean that the reality of STPs is quite concerning. For instance, in the black country there are plans for major changes to frontline services at the Midland Metropolitan hospital, including the closure of the hospital’s accident and emergency. The plans also propose to close one of the two district general hospitals as part of a planned merger. We know that by 2021 the health and social care system in the black country is projected to be £476.6 million short of the funds it needs to balance its books. [Interruption.] Government Members may shout now, but they are going to need an answer for their constituents when the reality of some of these proposed closures becomes apparent.
In Leicester, Leicestershire and Rutland, there are apparently plans to reduce the number of hospitals in the area from three to two. By 2021, the health and social care system in the area will be £700 million short of the money it needs to balance its books. In Suffolk and north-east Essex, the STP plan refers to the
“reconfiguration of acute services within our local hospital, Colchester Hospital University Trust”.
The whole House knows that, historically, reconfiguration in the NHS has meant cuts. There are also plans to close GP practices.
The context of these plans, of which I have given an idea, is the current NHS financial crisis. Most recently, we have heard from NHS providers about this financial crisis. They represent the NHS acute, ambulance, community and mental health services. NHS providers say that despite the best efforts of hardworking staff, including junior doctors, hospital accident and emergency performance is the worst it has ever been. Waiting lists for operations, at 3.9 million, are the highest they have been since December 2007. We ended the last financial year with trusts reporting the largest deficit in the history of the NHS: £2.45 billion.

Simon Burns: Will the hon. Lady give way?

Diane Abbott: I have to make a little progress.
Many STPs will be facing a large financial deficit. [Interruption.] I have to say to Government Members that they do not seem to be taking this debate seriously. When their constituents come to them asking about these cuts and closures, they will have to take it seriously then. Many STPs will be facing a large financial deficit, which is subject to “control totals”—that is, cuts. In the case of north-west London, which does not have the largest projected deficit by any means, spending on acute care is projected to fall in nominal terms over a six-year period, despite a population that is both increasing and ageing, and despite cost pressures such as the sharply rising cost of drugs.
STPs have made an assessment of their own deficits by 2020-21. Researchers have disclosed that approximately 29 of the 44 STPs have projected substantial deficits.

Simon Burns: Will the hon. Lady give way?

Diane Abbott: I have to make some progress.

Richard Fuller: On a point of order, Mr Deputy Speaker. Is it a requirement for a Member of this House to know the difference between a debate and a monologue?

Lindsay Hoyle: It is for me to make that decision. I am quite happy for the shadow Secretary of State to decide whether she wishes to give way or not. In fairness, this is an Opposition debate, and the hon. Lady is leading it. Let us not have any more pointless points of order. I am worried about how many Members want to speak; I want to try to get everybody in.

Diane Abbott: So when the STPs talk about efficiency, they actually mean cuts. Increasingly at the heart of these STPs are asset sales of land or buildings to cover deficits. No wonder the leader of Hammersmith and Fulham Council, Stephen Cowan, has said of his local STPs that
“this is about closing hospitals and getting capital receipts”.
He went on:
“It’s a cynical rehash of earlier plans. It’s about the breaking up and the selling off of the NHS.”

Simon Burns: rose—

Diane Abbott: I need to make some progress.
The King’s Fund has said:
“There are some concerns that NHS leaders have focused their efforts on plans for reconfiguring a few hospital services, despite evidence that major acute reconfigurations rarely actually save money and sometimes fail to improve the quality of care.”
The BMA has said the same thing. The King’s Fund has also said:
“The cuts under the STPs are eye-watering”.

Anna Soubry: rose—

Diane Abbott: I am anxious to complete my remarks so that Conservative Members will all get a chance to intervene in the debate.
The Health Select Committee's recent report on the impact of the 2015 spending review stated:
“At present the Sustainability and Transformation Fund is being used largely to ‘sustain’ in the form of plugging provider deficits rather than in transforming the system at scale and pace. If the financial situation of trusts is not resolved or, worse, deteriorates further, it is likely that the overwhelming majority of the Fund will continue to be used to correct short-term problems rather than to support long-term solutions”.

Simon Burns: rose—

Anna Soubry: rose—

Diane Abbott: Other aspects of the STPs that relate to cutting expenditure involve a combination of factors, including the use of new technology such as apps and Skype, patients taking more responsibility for their own health, “new pathways” for elderly care, increased reliance on volunteers and the downgrading of treatment by skills, responsibilities and pay bands. It seems to me that while some of these proposals might have some merit in themselves, it is delusional to imagine that they will deal with the financial black hole in the NHS. There is no evidence that among the patient population as a whole, increased use of apps, Skype and telemedicine can produce the efficiencies required while beds, units, departments and hospitals are being closed.
I remind Members, many of whom speak to their constituents in their advice surgeries on a weekly basis, that the truth about speaking to people face to face is that it is often towards the end of the conversation that people will come out with what really concerns them. My concern about the increased use of Skype is that many patients will not get the familiarity and comfortableness with their interlocutors to enable them to say at the end of the Skype session what it is that they are concerned about.
The STPs talk a great deal about increasing preventative medicine. That would indeed have the effect of lowering demand for acute NHS care, but it would also require a very substantial investment in public health programmes—and this Government have just cut public health funding. The elderly, the poor and patients for whom English is not their first language are the least likely to use these apps, telemedicine and Skype. It is inappropriate and unrealistic to assume that elderly patients who, I remind Members, are the biggest users of acute care and the fastest-growing demographic, will want to use Skype for any sensitive matter. “New pathways” for the elderly is sufficiently vague as an idea to raise alarm bells, given the projected rise in demand for geriatric services and continuing cuts in social care funding.

Andrew Gwynne: My hon. Friend is making a very important point. She has already touched on the financial problems in the NHS, but allied to those are the financial problems in adult social care. We shall not have the truly integrated health and social care that we all desire when these STPs are being swept under the doors without people knowing precisely what they will mean for public services in their areas.

Diane Abbott: My hon. Friend has made an important point.
The danger is that, in a blizzard of apps and Skype, patients—particularly the elderly—will find it harder to access one-to-one care, and that those who can afford it will find themselves forced into the private sector.
Let me now say a word about the increasing private sector involvement in the NHS.

Simon Burns: Will the hon. Lady give way?

Diane Abbott: It was the NHS England director of STPs, Michael McDonnell, who said that they
“offer private sector and third sector organisations an enormous amount of opportunity”.
We know that PricewaterhouseCoopers has been heavily involved in the formulation of a large number of these plans, and we know that—as was mentioned earlier—GE Healthcare Finnamore, which was taken over by General Electric in the United States, has been heavily involved in the formulation of plans in the south-west and possibly more widely. The strong suspicion is that a combination of cuts, the reorganisation of services on a geographical basis, and the growth of hospital “chains” will facilitate greater privatisation of the NHS.

Andrew Murrison: Will the hon. Lady give way?

Anna Soubry: Will the hon. Lady give way?

Simon Burns: Will the hon. Lady give way, and if not, why not?

Diane Abbott: Let me now draw my speech to a close. It is absolutely right that health and social care stakeholders should come together to plan for the future. It is absolutely wrong that social transformation plans should be hatched in secret and used as a cover for cuts and hospital closures—and it is increasingly clear that STPs may be a stalking horse for more privatisation. Conservative Members may not take this issue seriously—[Interruption]—and Conservative Members’ response may be to shout, but I stress to the House that the consequences of these STPs will be very material for all our constituents.

Anna Soubry: Will the hon. Lady give way?

Diane Abbott: They will also be very material for those who work in the NHS. I take this issue seriously. [Interruption.] That is why we have called the debate, and I wait with interest to hear what Ministers have to say.

Philip Dunne: It is a pleasure to be here today, and I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her post. I think this is the first time she  has opened a debate in her present position, and I am pleased to be doing so for the first time myself. I believe that she was appointed about three weeks before me, and I think it would be fair to say that we are both on a steep learning curve.
I am also pleased that the hon. Lady has chosen the sustainability and transformation plans as the subject of the debate, because that gives me an opportunity to correct some of the misconceptions that she has just revealed, and, more importantly, to inform the whole House of the status of the NHS’s plans. Let me begin by reminding the House of their origins. The NHS’s own plans for the future, set out in the five year forward view and endorsed by the Government—but not, as it happens, by the Labour party— recognised three great challenges facing the NHS: health and wellbeing, care and quality, and finance and efficiency.

Bill Wiggin: May I congratulate my hon. Friend, and say how delighted I am to see him at the Dispatch Box and fulfilling such a crucial brief? While he is on his steep learning curve, will he visit Hereford County hospital, so that he can understand the difficulties faced by rural patients and see what he can do to help us?

Philip Dunne: I am delighted to accept that invitation from my neighbour and friend, not least because many of my constituents look to Hereford County hospital for their acute care, but also because it is one of the hospital trusts that are in special measures, which is my specific responsibility. I look forward to seeing my hon. Friend there, perhaps even during the coming recess.

Norman Lamb: I wish the Minister all the best in his new role. Does he share my concern about the evidence from around the country that in many areas, mental health is peripheral to the STP process? Will he ensure that no STP plan will be accepted unless mental health is central to it?

Philip Dunne: I am grateful for that intervention from the right hon. Gentleman, who has taken such a personal interest in this subject. I can confirm that mental health is one of the issues that will be addressed in each of the plans that will be taken forward. I hope that reassurance helps.

Several hon. Members: rose—

Philip Dunne: I am going to make a little progress, as I have only just started.
The five year forward view also recognised that the challenges facing different areas of the country differ, so the issues facing Hackney are not the same as the issues facing Ludlow, and a single national plan would not be effective or appropriate. Indeed, the Labour party recognised that in its 2015 general election manifesto, which most Labour Members present stood on. It said:
“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”

Simon Burns: Will my hon. Friend give way?

Catherine West: Will the Minister give way?

Philip Dunne: I give way to the hon. Lady.

Catherine West: I thank the Minister for giving way and hope he does well in his first performance here in the House. What percentage of acute trusts are in deficit, and what proportion of clinical commissioning groups are in special measures?

Philip Dunne: It is the case that many trusts were in deficit in the last financial year, and those deficits were funded by the Department of Health. Looking forward, we are using the financial discipline of control totals not to instigate cuts, as the hon. Member for Hackney North and Stoke Newington suggested, but to hold the accountable managers to account for delivering within the financial envelope that those control totals represent. That is what a responsible Government do—we give money to public services and expect them to live within those means. This year the NHS has received one of the largest cash settlements it has ever had, three times more than the rate of inflation.

Andrew Murrison: I am very grateful to my hon. Friend for giving way, a courtesy not extended by the Opposition Front Bencher.
May I ask my hon. Friend to look very closely at STP footprints? The previous experience of those of us who represent rural areas is that aligning our areas with more urban centres can often mean that our constituents get a raw deal, and since my footprint includes urban areas in Bath and Swindon I am slightly concerned that the same thing may happen again.

Philip Dunne: If I manage to get there, I am going to come on to the footprints and how it was that 44 areas were identified, but in rural areas in Wiltshire and Shropshire, we do look to urban areas to provide the acute care for all our local residents, so it is appropriate that the footprint areas encompass both the acute and the full range of primary sectors.

Jim Cunningham: I welcome the Minister to his new job. What is happening in relation to bed-blocking, and what are the Government and the national health service doing to deal with care in the community in particular?

Philip Dunne: The hon. Gentleman raises a critical point and one of the real challenges facing the NHS at present, which is how to make discharge out of the acute setting, and movement right the way through the patient flow, more effective. As I will come on to say—if I get there—that is precisely why we are looking at bringing local authorities into the footprints for these STPs, so that the entire patient pathway can be taken into account.

Several hon. Members: rose—

Philip Dunne: I will give way to my right hon. Friend the Member for Chelmsford (Sir Simon Burns), who has been most persistent in trying to participate in this debate but has not so far been allowed.

Simon Burns: I am very grateful to my hon. Friend. So that there can be no misunderstanding, because the shadow Secretary of State does not seem to  have fully grasped the brief, will my hon. Friend, with his superior knowledge, explain categorically to the House about transparency in the health service with regard to not only STPs but other reconfigurations? There automatically always has to be a public consultation with local communities before any decisions are made, something that the shadow Secretary of State seems to be totally oblivious of.

Philip Dunne: I am grateful to my right hon. Friend, who has a great deal of experience in this area, having served in the Department for many years. He has pre-empted what I am about to say, which is that all the STPs will be subject to full and appropriate public consultation once we are in a position to do that.

Several hon. Members: rose—

Philip Dunne: I am going to continue my remarks, as I have already been quite generous in taking interventions.
As part of its annual planning round in 2015, NHS England published planning guidance last December—nine months ago—calling for clinical commissioning groups to come together with their providers across entire health economies to develop a collective strategy for addressing the challenges in their area. Those are the sustainability and transformation plans. There are 44 areas, which were agreed six months ago in March. They cover the whole of England, bringing together multiple commissioners and providers in a unique exercise in collaboration. Their geographies have been determined not by central diktat but by what commissioners and providers felt made the most sense locally.
Each area has also identified a strong senior leader who has agreed to chair and lead the STP process on behalf of their peers. They are well respected, credible figures in their local health economies, and we and NHS England are committed to supporting them to bring people together to agree a shared plan for how best to improve and sustain health services for their local populations. Local authorities, too, are fully engaged in the development of the plans. In some cases, local NHS organisations have agreed with local authorities that a senior council leader will lead the STP for their area. I think that is happening in Birmingham—I see a number of Birmingham Members present.

Maria Eagle: It is clear from the leaked document that Merseyside and Cheshire are looking to save £1 billion by 2021. In that context, does the Minister not agree that there will be an outcry when the secret proposals—which have now been leaked—to merge much-loved hospitals and cut services in Liverpool, for example, are finally consulted on? Does he acknowledge that they will have no chance of receiving any support?

Philip Dunne: The hon. Lady is leaping much too far ahead. There are no proposals at this point—[Interruption.] I will explain the exact state of the STPs shortly. There are a number of draft ideas to try to improve the services that are delivered to patients. Looking to the future and the efficiencies that need to be provided, as part of the five-year forward view the NHS leadership asked the Government to fund £8 billion of additional cash for the NHS. We provided £10 billion; the Labour party refused to provide anything like it. In return, the NHS agreed to look for £22 billion of efficiencies up to 2020. We have assisted it through the efforts of Lord Carter,  whom we asked to undertake a review of efficiencies across the NHS. He has identified 10 work streams in which clear efficiencies can be found—many of which, incidentally, have been identified by Opposition Members. The hon. Member for Hackney North and Stoke Newington herself has referred in the past to areas of the NHS in which there is waste, and a newspaper article this week by the former Chair of the Public Accounts Committee, the right hon. Member for Barking (Dame Margaret Hodge), referred to “absurdities” in the spending practices in the NHS. We are trying to put right some of the practices that have been swept under the carpet for too long.

Heidi Alexander: rose—

Philip Dunne: I am going to make some progress.
I turn now to the timetable and the progress that has been made so far. Each area was asked to work together over the first six months to draw up its initial thinking into a first draft plan by the end of June. Those plans were individually reviewed by senior leaders from NHS England and NHS Improvement during July and August. Each area is now in the process of developing its STP, with a view to submitting a worked-up plan to NHS England in October. The plans, as one would expect, will vary in their proposals, but all are expected to demonstrate a shared understanding of where an area is in relation to the three challenges set out in the five year forward view and where they need to be by 2020-21.

Gareth Thomas: I am grateful to the Minister for giving way. He was very generous the last time I had an opportunity to intervene on him.
Part of the concern in my constituency about the north-west London STP relates to the fact that Harrow receives less NHS funding per patient than any other part of London. For some months we have sought a meeting with a Health Minister to discuss that issue. Is the Minister prepared to receive a delegation from our clinical commissioning group?

Philip Dunne: I am grateful to the hon. Gentleman for his kind words about my willingness to take interventions from both sides of the House.
I am interested that the hon. Gentleman should mention funding allocations. Across the NHS, the allocations are a legacy of the formulas that were set in place by the Labour Government, of which he was a member. People across the country, not least in rural areas such as Shropshire, cannot understand why the funding per capita is much less generous in some parts of the country than in others. I am taking an interest in that and would be willing to sit down with him and other colleagues to understand the particular circumstances in north-west London, which we will have to do after the coming recess.
Returning to the progress that is being made, all the plans are expected to present an overall strategy for their area and to identify the top three to five priorities required. In the most advanced plans, we are also expecting areas to set out how they will deliver a number  of national priorities, including on mental health and diabetes. Some will build on the early work of vanguard or Success Regime joint working, which has been developing better co-ordinated care models over the past year or so.

Sue Hayman: Will the Minister give way?

Philip Dunne: Shortly. I must make some progress.
The plans offer the NHS a unique opportunity to think strategically. For the first time, the NHS is planning across multiple organisations—both commissioners and providers—with local authorities to address the whole health needs of an area and the people it serves. Also for the first time, the NHS is producing multi-year plans showing clearly how local services will develop over the next five years to deliver real improvements in patient care and better efficiency to ensure that the NHS continues to be able to cope with rising demand from our ageing population. That is leading some STPs to face up to tough choices about the future of some services. Such choices have often been postponed again and again because they were too hard or relied on individual organisations operating on their own to shoulder the responsibility rather than it being shared across the geography or the whole healthcare economy.

Antoinette Sandbach: Does the Minister recognise the concerns in constituencies such as mine that have a border with Wales? The numerous closures of hospitals in Wales by the Labour Welsh Government are placing pressure on NHS trusts in Cheshire and Merseyside.

Philip Dunne: My constituency also shares a border with Wales, so I am acutely aware that Welsh patients regrettably have to wait longer and have worse access to treatment than those in England. Many of them look to English hospitals for services that are unfortunately not available in Wales, in part due to a conscious political decision of the Welsh Government to allocate less funding to the health service in Wales.

Alex Cunningham: I met a young surgeon at my north-east hospital in a personal capacity last week. She was excellent and caring and was clear in what she had to explain to me. She was so dedicated that it made me proud that she worked for the NHS. I was not proud, however, to hear about the facilities with which she has to work following the cancellation of our new hospital project in 2010 by the Tory-Lib Dem Government. Does the Minister agree that we can have as many plans as we like, but if we do not have the infrastructure, we cannot deliver the care required by some of our neediest communities?

Philip Dunne: There is undoubted pressure on infrastructure, as there is on technology. As technology improves and becomes available to the NHS, it provides opportunity—for example, for much more care to be undertaken closer to the patient. In many cases, this can be done increasingly in or near their home. That will have consequences for our existing infrastructure estate, and some of that will lead to a reconfiguration of existing hospital services. There is a programme of renovation across our hospitals, but of course that cannot get to everywhere at the same time. I apologise to the hon. Gentleman that he does  not have the shiny new hospital that he would like, but there is a building programme, which will continue in the future.

Sue Hayman: rose—

Philip Dunne: I will now give way to the hon. Lady, who has been very patient.

Sue Hayman: I appreciate that. As the Minister is aware, we face particular issues in Cumbria, which has led to our having the Success regime. We are about to go into consultation on that, in key areas such as maternity, accident and emergency and the community hospital’s future. My constituents are concerned about how the STPs are going to fit in with the Success regime, what the fit will be and whether all that will be challenging and confusing.

Philip Dunne: As I have said, and as the hon. Lady knows, the Success regime in her area will become subsumed within the STP, but the advantages for areas in the Success regime is that it means the organisations have been working together for much longer than in the pure STP areas, and that will bring benefit in terms of the maturity of their plan and their willingness and ability to implement it.

Several hon. Members: rose—

Philip Dunne: I am not going to take any more interventions, as I am going to have to wind up shortly.
The hon. Member for Hackney North and Stoke Newington has raised concerns in her remarks today and outside this place, and I would like to address a few of them before I finish. She has said that the STPs will result in significant cuts and changes to front-line services. I wish to make it absolutely clear to the House that, for all her protestations, these plans are not about cuts; they are about local areas, including commissioners, providers and local authorities, coming together and deciding how to improve services in the medium and long term. Some areas are taking difficult decisions, often looking to tackle long-standing problems, but this will be subject to rigorous local and national scrutiny. I can categorically assure her and this House that no changes will occur without local consultation and the normal process in the event of any proposed reconfiguration.
The hon. Lady has also accused the STP process of lacking transparency, being undertaken in secret and lacking time. Planning within the NHS is not new; an annual planning round culminates in December each year. As I have said, NHS England announced STPs publicly in its planning guidance published in December last year, and since then local STPs’ leads have been engaging locally, as they deem appropriate—there has been no secret. What is new is that for the first time in years different NHS bodies, with local authorities, have been working collaboratively together to develop these plans. The 44 local areas are submitting their worked-up plans to NHS England for consideration in October. The NHS will scrutinise these plans and make recommendations over which to take forward and prioritise for discussions with Ministers and for formal public consultation, which will follow. Implementation will take place once the feedback from consultation has been assessed, so that this implementation will begin from early next year, with timings dependent on each individual area’s specific proposals.
The hon. Lady has claimed that the process does not allow for adequate public or parliamentary engagement. These proposals remain at a draft stage, but we have made it clear to local leaders that they are responsible for ensuring that plans engage with all local stakeholders when they are ready, and proposed changes will be subject to local consultation. Many have already engaged with groups of clinicians and other stakeholders in their area in preparing draft plans. I have also indicated that local areas will be launching public consultations shortly, once their updated plans have been scrutinised by NHS England, and we welcome involvement from the public and from MPs. I have no doubt that there will be opportunities in the coming months for us to continue these discussions in this House and in the Department, and I will be willing to talk to MPs who are concerned about activities in their area.
The hon. Lady has called on the Government to publish the plans. As I have said, these plans are being prepared by local areas within the NHS, and they will be published and subject to further consultation in due course. She has also raised concerns about the use of private sector advisers in developing the STPs. I just point out gently to her the irony that 38 Degrees, which she prayed in aid for much of her advice in preparing for this debate, relied itself on a private sector advisory group, whose report I happen to have here—Incisive Health, a recognised private sector adviser within the NHS and elsewhere. It is a bit rich of her to come to this House arguing against the use of the private sector when she does so herself.

Philippa Whitford: I am sorry that this is such an acrimonious debate. I welcome the principle of the sustainability and transformation plans, as they are a key opportunity to reverse fragmentation and to reintegrate the NHS, but we have to get it right. To turn this whole matter into just a game of moving the deckchairs on the Titanic is something that we would all regret in a few years’ time. We are talking about a place-based approach, which is very similar to what we have in Scotland. I absolutely welcome it, but the places must be right—they need to cover the whole population and the geography must make sense. That is in the relationships of the organisations that are there, but we have to think of things such as public transport. There is no point plonking a community in an STP if there are no connections to it. How these places are designed is really important, as are the partners that are in them. All of this should be about integration and re-integration from acute care through to primary care and local authority care. We need single pathways and wraparound patient-centred care.

Andrew Gwynne: I have some sympathy with what the hon. Lady is saying. Does she agree that that integration will not happen if any one part of those partnerships is severely underfunded? For example, she mentions local authorities. Many of the pressures in the NHS today are solely as a result of the severe underfunding of adult social care. Do we not need to ensure that the finances are in place for these STPs to work?

Philippa Whitford: I totally agree with the hon. Gentleman. I was about to come on to that. However, it is not just the funding, but the entire model. The tariff model that  we have at the moment rewards hospitals for doing more minor things, and punishes them for doing more acute things. Taking on more A&E cases and more complex cases, working harder and doing more make their deficits grow. Our problem is that we have all sorts of perverse incentives in the system that mean that organisations will still be looking out for their budgets and their survival instead of working together.
In Scotland, we got rid of hospital trusts and primary care trusts, and, since 2014, we have had integrated joint boards. Those boards were handed joint funding that came from health and the local authority, which meant that the whole business of “your purse or my purse” disappeared. They were then able to start to look at the patient’s journey and the best way to make the pathway smooth. That is what we want to see.
Having a shared vision of where we are trying to go to is crucial. That means that stakeholders—both the people who work in the NHS and the people who use it—need to believe in where we are trying to get to. Public conversations and public involvement are the way forward. We should not be consulting on something that has already been signed off, but involving people in what they would like the plans to be, as that would make those plans much stronger.
We need to make deep-seated changes to the system, as opposed to only talking about the money for the deficits. This is something that the Health Committee has been talking about for ages. The phrase “sustainability” has become shorthand for paying off the deficit. Of the £2.1 billion earmarked for sustainability and transformation, £1.8 billion is for deficits, which leaves only £300 million to change an entire system. I know that we talk about money a lot in here, and of course it is important, but we have far bigger sustainability issues than the £2.5 billion deficit in the NHS. We have an ageing population, and those people are carrying more and more chronic illnesses, which means that we have more demand, more complexity and more complications. That is one of the things that is pushing the NHS to fall over. On the other side of that, we have a shortage in our workforce; we do not have enough nurses or doctors, and that includes specialists, consultants, A&E and particularly general practitioners. Although the advice has been very much that finances were third, and prevention and quality of care were meant to come first and second in delivering the five year forward view, finances seem to be trumping everything else.
It is absolutely correct that health is no longer buildings; there are lots of methods of health that are bringing care closer to patients, and also some things that are taking patients further away from their homes. We have hyper-acute stroke units, and we have urgent cardiac units, where they will get an angiogram and an angioplasty that will prevent heart failure in the future. However, we cannot start this process there; we cannot shut hospitals and units to free up money to do better things. We have to actually go for the transformation and do the better things first. We have to design the service around the pathways we need—that wraparound care for patients—and then work backwards. If more health and treatment is coming closer to the patient, at some point they will say, “Actually, I don’t go to the hospital very often. I want the hospital to have everything it needs when I need it.” Then we can look at the estate to see whether we have  the right size of units and the right type of units in the right place. What concerns me is that the process we have seems to be the other way around—we are starting with hospitals, which is often a very expensive thing to do, and hoping it will deliver everything else.

Norman Lamb: rose—

Philippa Whitford: I give way to Norman.

Norman Lamb: I am grateful to the hon. Lady for giving way, even if she used my first name. Does she share my concern that, out of the original sum allocated for this sustainability and transformation process, the vast bulk appears to be going, in effect, to propping up acute trusts that face substantial deficits, and that little is available for transformation?

Philippa Whitford: As I said, the proposals leave only £300 million. We cannot transform a system on the scale that is being considered with £300 million.
As I said, the guidance talks about prevention. We need to be tackling health inequalities. We need to be focusing on health and wellbeing—and by that I do mean physical and mental wellbeing. We need to be strengthening public health—something else that has been cut. We need to be looking at the quality of health and care, and that means right across into social care. We must fund social care, because it can make a difference to things like delayed discharges. We are not even three years into the integration in Scotland—we are only two and a half years into it—but delayed discharges have dropped 9%. Yet, the last time the Secretary of State was in the Health Committee, they had gone up 32% in NHS England. So literally just moving things around and allowing one part of the system to fail will mean that the entire system fails.

Andrew Murrison: I always listen with great care to what the hon. Lady has to say, and I agree with a great deal of it. Does she agree that part of the problem in England in relation to delayed discharges has been that we have seen a retrenchment of community hospitals and their beds, which have provided step-up, step-down care—intermediate care beds. Unfortunately, they are no longer available, which means inevitably that hospital discharges are delayed, with all the distress that causes.

Philippa Whitford: I totally agree with the hon. Gentleman. I think it is about care in the home for those who are able to have that and convalescence for those who require it; that, basically, is the step up, step down. In my health board in Ayrshire and Arran, we have rebuilt the three cottage hospitals. They are now modern, state-of-the-art, small units. That means that our population has less far to travel and that older people will not, in the end, need to come to hospital. Now, we are still in that transition; those units are not doing everything they have the potential for—indeed, we are a rural population. However, certainly in Scotland, there is much more recognition that we need intermediate care between people being at home and being looked after by their GP, and people ending up in a very expensive acute unit. It is not just about finance; any Member who has been in hospital knows they do not want to be there, and nor do our elderly population. These levels of care are therefore crucial, and it is important that that grows out of the STPs. I see that as a crucial opportunity for the NHS, which cannot be missed.

Barbara Keeley: Does the hon. Lady agree that there is a startling fact about the underfunding of social care that Ministers cannot get away from, whatever they do or say? We have heard today of the case of care workers who are suing the contractor that they work for because they were paid only £3.27 an hour. How can somebody be discharged from hospital in an adequate way when that is the domiciliary care that will be waiting for them? It was interesting to hear the former care Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), say this morning that
“we have not got the cost of…adult social care really sorted out.”

Philippa Whitford: I totally agree with the hon. Lady. I am not sure whether she took part in the carers debate that we had not that long ago, where I pointed out that unless we develop social care as a profession, then we all face a fairly miserable time in our old age. Nursing is a profession that is recognised and valued, and caring for our older ill population should also be recognised. We need to recognise them, to give them time to do their jobs, to pay them adequately, and to give them a career development structure that means that we bring the best people up and get them running teams.
As I said, I am disappointed by the aggression on both sides of the House. I know that such a debate is always a good tennis match for point-scoring, but the development of the STPs is an opportunity to do things that everyone in this House would agree with. However, if it is not done properly—if it is just a fig leaf whereby we pretend that something is being done—the NHS will suffer and we will be the generation of politicians who moved the deckchairs on the Titanic.

Sarah Wollaston: It is a pleasure to follow my colleague on the Health Committee, the hon. Member for Central Ayrshire (Dr Whitford).
I absolutely agree that we should see this as an opportunity to move away from a fragmented system where people are perhaps commissioning and providing care in isolated silos to one that looks across the whole system, and across geographical areas, so that we can move towards a truly integrated approach between health and social care. To do that, local authorities, as well as the health system, need to be involved in the STPs—and crucially, we need to involve local people. The lesson that we learn from every major reorganisation has been that if we take local people with us on the journey, and on the thinking behind it, it is much more likely to be successful. We should not see genuine local consultation and engagement as an inconvenience but as something that improves the eventual plans.
It is a real shame that this debate has developed a hashtag of “secretNHSplans”. I am afraid that NHS England now has to look at that, take a step back, and ask how it could have been better at engaging local communities—and those who represent them. It is a great shame that Members across this House were unable to see the draft plans until they were leaked to the press. That is not the right way forward for any genuine engagement.

Maria Caulfield: Does my hon. Friend agree that if staff, whether nurses, doctors, physios or pharmacists, had been involved right from the start of  the process, that would have helped staff morale in the NHS, which is struggling, and that they probably have the best ideas of anyone as to how the STPs could progress?

Sarah Wollaston: I absolutely agree. This is about local communities and their representatives. Public meetings are important, but so are involving bodies such as HealthWatch and making sure that under-represented groups are involved. The right hon. Member for North Norfolk (Norman Lamb) talked about the need to involve mental health services in these plans. It is very important that we make sure that under-represented groups are involved, and that does include those who use mental health services.

Jack Dromey: The hon. Lady, with her lifetime of experience in the national health service, is absolutely right about the importance of consultation. Does she therefore understand the concern being expressed by the staff at the Dove sexual health centre in one of the poorest constituencies in England, Erdington, because none of its 2,000 patients has been consulted, and neither have any stakeholders, about a proposal to close this absolutely vital facility?

Sarah Wollaston: I thank the hon. Gentleman for his intervention. As I said, the plans that are produced at the end of the day will be better if we involve those who are using the services and those providing them, as well as those commissioning them, as we go along, rather than present a plan, even if it is a draft, as a fait accompli, because then it becomes a binary choice rather than one where people can make suggestions to improve the plans as they develop.

Philippa Whitford: I know that Scotland is a lot easier to get around in population terms, although size and transport are not always that easy, but one of the mechanisms that the Scottish Government use when developing strategies is what they call the national conversation, whereby the ministerial team literally go walkabout and have meetings to hear from people directly before anything goes on paper.

Sarah Wollaston: If we get too caught up in the process of consultation, we will not address the other serious hurdles in the way of STPs achieving their aims, chief among which is the issue of finance. The NHS is now in its seventh year of a historic level of austerity, and the average of a 1.1% annual uplift in funding for the NHS over the past six years represents an extraordinary challenge in the context of increasing demand. It is good that we are living longer, but we are doing so with much more complex conditions, and the treatments available to tackle them are more expensive. We need to be clear that, because of that, and even though the settlement for health has undoubtedly been generous in relation to other Departments, a significant gap is opening up in health, and the situation is even worse in social care.
Figures from the Association of Directors of Adult Social Services show that 400,000 fewer people are in receipt of social care packages in 2015-16 than there were in 2009-10, and not only are fewer people receiving social care packages, but those packages are smaller. Many STPs are about transferring care into the community.  We need to make sure not only that the funding is available to provide those social care packages, but that we have the workforce to deliver them. The proposal in the area that I represent is to close two community hospitals that are used by my constituents. As a former rural general practitioner, I know just how important those facilities are to local people. They are special to them not only because of the step-up, step-down care that they provide and to which the hon. Lady has referred, but because these are the places that more people like to be at the end of their lives. They provide personal care and allow people, particularly those in rural areas who are doubly disadvantaged by not being able to travel to larger local centres, the opportunity to be treated closer to home.

Antoinette Sandbach: In my constituency, Tarporley cottage hospital has been adopted by the local community and continues to provide that step-up, step-down care without being part of the NHS. I wonder whether my hon. Friend would be interested in meeting some of the hospital trustees. It may provide some hope for the future as an example of how communities can come together and support their local assets.

Sarah Wollaston: I thank my hon. Friend for that invitation. In fact, I have visited the Community Hospitals Association on many occasions, to hear from community hospitals around the country. I will continue to do so and I commend them for the valuable role that they play.

Andrew Murrison: Does my hon. Friend agree that community hospitals can also keep the bean counters happy? If they get the case mix right, it is much more affordable to treat people in community hospital beds than in an acute unit, which is extraordinarily costly. Furthermore, that would clearly give patients what they would like, which is care close to their homes, as my constituents in Warminster—we still have community hospital beds—will attest. I know that my hon. Friend the Member for North Dorset (Simon Hoare) would say the same for Shaftesbury.

Sarah Wollaston: Members on both sides of the House are aware of how valuable and important community hospitals are to our constituents. Taking that a step further, I would say that the best bed for any patient is their own bed, provided that they can be given the right package of care close to home. We know that there are many people even in community hospital beds who do not need to be there. They are there for want of the right social care package that could enable them to be at home.
In welcoming STPs, we should be realistic about the financial challenge that they also face and the costs sometimes of providing those services. That is a huge challenge for them. In my area alone the STP is facing a £572 million shortfall by 2021 if no action is taken. I can understand why, for example, it will look at the relative cost of providing care to people in acute hospitals, in community hospitals and at home, and make an argument that sounds very reasonable about how a larger number of people could be much better cared for at home.
I return to the point that the hon. Member for Central Ayrshire (Dr Whitford) made. Access to the transformation part of the sustainability and transformation plans is necessary to be able to put those services in place and very often to build the infrastructure that we need. For example, in Dartmouth in my area, the possibility of providing more care closer to home within a community hub will require the up-front funds to build a new centre that allows the workforce to be developed and more services to be provided closer to home. Unfortunately, what we often see is the closure of a much loved facility without the new service in place.
As the sustainability and transformation plans progress, I would like to see a genuine focus on the opportunities to provide more care closer to home. I fear that we will miss that opportunity because, as we have heard, £1.8 billion of the £2.1 billion sustainability and transformation fund is going towards the sustainability bit, for which read “plugging provider deficits”, and only £300 million is left nationally to put in place all these plans.
We know also that part of the way that the Government have managed to fulfil their promise to NHS England in respect of the funding that it asked for has been by taking funding out of capital budgets because those are essentially flat cash, and also by taking money out of Health Education England budgets and public health budgets. It concerns me that many of the principles behind the sustainability and transformation plans are put at risk by other parts of the system being squeezed. We have heard the point about prevention. Central to the achievements of the sustainability and transformation plans is the prevention piece—the public health piece. It is a great shame that public health budgets have been squeezed, limiting the ability of those aims to be achieved.
I know that many Members wish to speak so I shall move on and make some asks of the Minister, if I may. There is more that the Government can do. We on the Health Committee were very disappointed that none of the witnesses who came before us from NHS England, NHS Improvement or the Department of Health was able to set out the impact of cuts to social care on health planning. We need to do much better at quantifying the cost to the NHS of cuts to the social care budget.
The Minister needs to take the long view on prevention and help the service by implementing policies that could help local authorities to make changes. For example, I suggest making health a material consideration in planning and licensing, in order to provide the levers to make a difference. We need a much greater focus on workforce, because the STPs cannot achieve their aims if the workforce to achieve them is not in place. Finally, will the Minister kindly visit my area to look at the proposals in the sustainability and transformation plans in south Devon, and at the opportunities and how we would achieve them?

Lindsay Hoyle: Order. The next speech, in the same way, will not have a time limit, but after that it will be five minutes. Some people will not get in. Please explain to them why those who took advantage of the time did so—it is totally unfair.

Heidi Alexander: I am grateful for the opportunity to speak in this debate. Sustainability and transformation plans—what are they, should the   public be concerned, and are the plans good, bad or a mixture of both? As we have heard, over the last eight months or so STPs have been drawn up in 44 areas in England by a range of people involved in the running of the NHS and local government. As far as I can work out, they have come about because NHS England could see that in the chaos following the previous Government’s Health and Social Care Act 2012, there was no obvious body responsible for thinking about how best to organise NHS services at a regional and sub-regional level, so NHS staff and local government officials were tasked with assessing the health and care needs of their local populations, considering the quality and adequacy of the provision to meet those needs, and developing ideas about how those needs might be better met within available resources.
So far, so good, we might say, but there are three big problems. First, the current financial pressures on the NHS mean that the plans are likely to be all about sustainability, not transformation. Secondly, this is a standardised process to define and drive change, so we run the risk of good proposals being lumped in with bad ones, and of some plans simply focusing on the achievable, as opposed to the necessary and the most desirable. Thirdly, it is an inescapable fact that these plans are being developed when there is huge public cynicism about the motives of a Tory Government when it comes to change in the NHS. If the Government want to deliver change, the debate with the public needs to start in the right place—not behind closed doors, and not using jargon that no one understands. It needs to be focused on patients and their families, not on accountants and their spreadsheets.
I think most people understand that the NHS cannot be preserved in aspic. They understand that compared with the 1950s, we now use the NHS in a very different way. At the moment, they simply see an NHS under enormous pressure. They are waiting longer for an ambulance, to see a GP, to be treated in A&E and for operations. They see staff who are stressed out and who are on the streets in protest. When Ministers and NHS leaders talk about sustainability and transformation, the public are therefore dubious. For sustainability, they read cuts, and in some cases they will be right—it will mean cutting staff, closing services and restricting access to treatment. No matter good the plan, how thorough the analysis or how innovative the solution, we cannot escape the basic problem of inadequate funding for the NHS and social care.

Kerry McCarthy: In my constituency, we are very concerned because Bristol is surplus but the footprint means that we will be going in with North Somerset and South Gloucestershire, which both have cumulative deficits. No matter what else is part of the plan, to us in Bristol it means cuts.

Heidi Alexander: That is the story we hear from all over the country. This is not profligate overspending on the part of NHS bosses or local government leaders; it is chronic underfunding on the part of Government. There was much fanfare associated with last year’s comprehensive spending review and what it meant for the NHS, but when we look at that financial settlement, along with the one in the last Parliament, we see a flatlining budget to deal with soaring demand.
As a country, we have a growing and ageing population. The reality is that in the last 10 years, the number of people living beyond the age of 80 has increased by half a million, and the NHS and social care are buckling under the strain. Although we should never give up on trying to organise the NHS in the most efficient and effective way possible, we have a choice. Do we want to cut services to match the funding available, or do we want to pay more to ensure that our grandparents and our mums and dads get the sort of care that we would want for them? If the NHS is to provide decent care for older people we need not only to fund social care adequately, but to find better ways of organising services to keep people out of hospital for as long as possible.
That leads me to the next problem. STPs are being used as a catch-all process to bring about change in the NHS, but many run the risk of focusing on the wrong things. They are being used as a vehicle to do different things in different places, and although some may lead to better treatment and better outcomes, the danger is that there will be knee-jerk, blanket opposition to everything. Some proposals will inevitably be controversial—the closure or downgrading of an A&E or maternity department will never be easy—but, in other cases, the plans may end up focusing on something that is not the burning issue.
Let me take my local area as example. The STP for south-east London proposes two orthopaedic elective care centres. The sites for them have yet to be decided, and the STP plan has yet to be signed off by NHS England. On the face of it, there is little wrong with the proposal to create centres of excellence so that all hip and knee replacements are done in one of two places. The problem is that when the front page of a national newspaper talks about the “secret” STP plans under which A&Es will close, my constituents fear the worst. “We’ve been here before,” they will say. They will smell a rat, even where one might not exist.

Alex Chalk: Will the hon. Lady give way?

Heidi Alexander: I will not give way. I am aware that many Members want to speak, and I wish to conclude my remarks.
My constituents ask me these questions. What happens if Lewisham is not the site of the new centre, its elective work is shifted elsewhere and the hospital then struggles to staff the emergency department? Is orthopaedic care really the burning issue in south-east London? What about the queues of ambulances outside the Queen Elizabeth hospital? What about the homeless young man who pitches up in A&E because he has nowhere to sleep and there is no support for him in the community?
Where will the money come from physically to redesign the NHS buildings that such a care centre would entail? With £l billion taken out of capital budgets and switched to revenue last year, it seems fanciful to think that there will money lying around for such projects. The NHS is on its knees. Everyone knows that hospitals ended up £2.5 billion in deficit last year. We have all seen the reports of A&Es closing overnight because they have not got the staff. We all know that GPs are run ragged, that ambulance crews are stressed out and that nurses are demoralised, and that is before mentioning the junior doctors.
This is the main problem for the Government: if you do not fund the NHS adequately and if you do not staff it properly, do not be surprised when the public do not trust your so-called improvement plans. There is deep public cynicism when it comes to anything this Government wants to do to the NHS. People believe Ministers are trying to privatise it. They believe services are contracted out to the private sector to save money, not to improve quality, and in many cases they are right. The problem is not STPs as such, but the context in which they are being developed—inadequate funding, an inability to make the case for change, a workforce crisis that is leading to overnight closure of services and, as a result of all of these, a deep public mistrust of the Government’s intentions.

Several hon. Members: rose—

Lindsay Hoyle: Order. There is now a five-minute limit.

David Tredinnick: I will be as brief as I can be, Mr Deputy Speaker. May I congratulate my old Whip on his elevation to being the Minister of State, Department of Health? I hope that he brings with him all the skills he learned at the Ministry of Defence, as there are many tough challenges ahead. At a time when there is upheaval in every Department in Whitehall, I suggest that this is a good time for him to look afresh at where the Department of Health is going, and I want to propose some initiatives.
This debate is divided neatly into sustainability and transformation. I suggest to the House that, if we are to have a sustainable health service, sustainability will need to be about reducing demand—we must look at ways of reducing the demand on the service—and if we are to have transformation, it will have to include increasing supply and looking for new types of treatments that are available.
I am proud to have represented the middle of England, Leicestershire, for many years, and in particular pretty much the whole area of Hinckley and Bosworth Borough Council. I would like to share the initiatives that the council has taken since the Health and Social Care Act 2012 came into being, and then suggest what we need to do beyond those kinds of initiatives, taken by a council that is very successful and, I might add, Conservative-controlled.
The council has taken three major initiatives in my constituency. One is getting people of all ages to be more active, including through young people putting on activities such as days for soccer tots aged two to four, bikeability courses for six-year-olds, BMX track work, parachute games, skipping and making smoothies. There are all kinds of activities. The council has also built a new leisure centre, which has been a huge success. The number of people attending swimming in the borough has gone up exponentially. It has produced some excellent facilities.
It is sad to relate, however, that in my constituency 7% of people have diabetes and 68% are recorded as having excess weight, of whom 20% are obese. Obesity in children is still increasing. My point is that however good local people are, we have to take other steps. I can  see the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), looking over at me, and she knows what I am going to say, because we worked on this when I was on the Committee: we have to have more action on obesity. The sugar tax is very important and welcome, but it is not enough. We have to deal with diet and food consumption. The template for moving ahead should be the campaign of more than 100 years to stop people smoking and stop cigarettes dominating our lives. That campaign really began with the passage of the Regulation of the Railways Act 1868, which mandated smoke-free carriages to prevent injury to non-smokers, and culminated in England going smoke-free in 2007.
As for the transformation of local services, we need more services, but some are not properly co-ordinated. I served on the Committee for the Osteopaths Act in 1993 and the Chiropractors Act in 1994. Both groups of practitioners are now regulated by an Act of Parliament, but osteopaths, chiropractors and orthopaedic surgeons do not talk. It is ridiculous. Far too many people are having operations who could be dealt with by chiropractors or osteopaths. The head of the Professional Standards Authority, Harry Cayton, regulates 17 registers and says that of the 63,000 practitioners on those 17 accredited registers, covering 25 occupations, far too few are being used in the health service. That is very sad.
I will finish on this point, for the benefit of the Chair of the Health Committee as much as anything: homeopathy has been officially recognised by the Swiss Government as legitimate medicine to coexist with conventional medicine, following a 2009 Swiss referendum—referendums are not only in Scotland—when two thirds of the population decided that they wanted homeopathy, acupuncture, traditional Chinese medicine, herbal medicine and holistic medicine as part of their health service. Swiss insurance companies now agree.

Nick Brown: I welcome the Minister and shadow Minister to their new responsibilities. The Labour party was right to choose this topic for the Opposition day debate. I wish the Minister well in confronting the financial difficulties that face him.
In confronting those difficulties, the Government’s five-year forward review, which was published in 2014, called for £22 billion of efficiency savings to be found by 2020, on top of the £20 billion of efficiency savings to be found between 2010 and 2015. I simply do not think that should or can be done. The total deficit in all national health service trusts reached £2.45 billion in 2015-16, a figure that is almost three times greater than in 2014-15 and almost half a billion pounds higher than the national health service’s own revised plan. Monitor estimates that even if all realistic efficiency savings were made, a deficit of £1.5 billion would remain in this financial year. It is simply not possible to deal with the situation through efficiency savings. The Government know that and are stuck, hence the sustainability and transformation plans covering the next five years, organised along 44 footprint areas that do not have any existing coherence with existing health service organisational boundaries. In the north-east, the Northumberland and Tyne and Wear footprint covers five clinical commissioning groups, six local authorities and seven foundation trusts.
Newcastle, the city I have the honour and privilege to represent, enjoys well run and efficient health services, which is a testament to staff working at all levels in the NHS there. Our health services are well regarded in the local area, but the sustainability and transformation plans raise at least three serious questions. If NHS England and NHS Improvement think that more than half of clinical commissioning groups are underperforming, why are they asking CCGs to draw up the key documents that will transform the structure of the NHS? Given that many CCGs will have to merge, where is the motivation for them to create clear, competent and credible plans? Given that the footprints will have no formal structure, who is accountable for the long-term consequences of the plans?
The approach that is being adopted bears a striking resemblance to the previous top-down, unwanted revision of the NHS that we were promised would not happen when the Government came to power in 2010. They are doing something that one would have thought difficult—they are breaking their promises twice.
This is not the first threat that the north-east has faced. We have faced the redistribution of moneys and the downgrading in the distribution formula of the social deprivation component, with far more emphasis being placed on the age-related part of the formula, which affects the well elderly rather than people who are ill.
In government, Labour promised to increase health spending to match the then European average of 8.5% of GDP. We kept that promise, but successive Governments since—the coalition Government and the Tory Government—have failed to commit funds to the NHS. That is why health spending as a proportion of GDP will fall to 6.6% by 2020-21, which will leave us lagging behind the OECD average spend of 9.1% and comparable countries such as Germany, which spends 11%.
The Government should be honest with people about the challenges the national health service faces and the response needed to meet them. The sustainability and transformation plans are a fundamentally bureaucratic response to the funding crisis in the NHS. As such, the Government completely misunderstand the fact that the NHS needs not more meetings but more money.

Richard Fuller: Change in life is frequently a source of anxiety or downright scary. When people are young and change schools, when they get married or when they start a job, that change is scary. There is nothing scarier for a community than change in how its health services are provided, so perhaps it is not surprising that the NHS has found managing change to be one of the most profoundly difficult things to accomplish.
As the hon. Member for Central Ayrshire (Dr Whitford) mentioned, we frequently face substantial or overwhelming challenges in society, with people growing older and having more complex needs, and the requirement for more expensive equipment and supplies to meet ever increasing standards for and expectations of healthcare in our country. The NHS was presented with two options for change. One is radical and will meet those challenges in a fine future that offers great health outcomes for all,  but sounds a little too scary. The other option is the incremental approach, which will move things along a little bit. It will not deal with the fundamentals but it will enable us to feel that we retain the institutions and structures with which we are familiar.
As someone who was born in Bedford hospital, grew up in Bedford and now represents Bedford, I am very familiar with each of the buildings and institutions in my community. To see them change is a very scary thing. When we consider processes of change, we have to recognise that the population start from that position of anxiety. It is therefore important that Members do not play on those anxieties. It is not effective opposition to create scare stories ahead of an outcome. That is not in the public interest. We can raise concerns, yes, but in a way that looks to the sensitivities of local situations. That is what I would like to focus on in my remarks: the specific circumstances of my part of the country.
I welcome the STP approach because of the integration of care with health and because it provides local authorities with a voice, for the first time, in decision making about local care choices. For the first time, the NHS will not be getting its own way, if this process lives up to the promise of local decision making. That will be helpful in getting local support and control. In my own locality, we have a cross-party community approach. We have a Liberal Democrat mayor, a Liberal-Labour group on the council and Conservative Members of Parliament. We are all united in an approach of wanting our voice heard on local care in the NHS. An STP is a way of us having that.

Philippa Whitford: Would it not therefore be have been more effective, particularly if there is cross-party working in the local authority, to have local consultation early on about what could be gained in exchange for what might be felt to be lost?

Richard Fuller: I very much appreciate the hon. Lady’s question, because it gets to my point. I am actually quite sceptical about what consultation means. She might not know that Bedford has been through a review process for our acute services. I was trying to measure the length of that process in terms of Members of Parliament for Corby: it preceded Louise Mensch becoming Member of Parliament, carried on through the whole period of Andy Sawford being Member of Parliament, and is now taking up the time of my hon. Friend the Member for Corby (Tom Pursglove). We do not involve Corby anymore; it is now just Bedford and Milton Keynes. That process included consultation and participation, with the NHS saying that it wanted to listen to people. It consulted them, yes. Did it listen to them? No. It was the NHS’s own process. It ticked all the boxes, but it was a complete and utter disgrace to local accountability.
I do not have distrust of Pauline Philip, chief executive officer and leader of our STP, and I do not need to know everything. I want to know that our local authorities are having their voice heard in the process just as much as our local CCG, as they are our representatives. I feel relatively comfortable that the process will lead to options that are more acceptable to the population, because it involves local authorities as well as the NHS. We should, however, expect the outcomes of the process to be highly varied around the country. Some will be correct  and acceptable, and will go forward. Others will be controversial, and others will be downright wrong. We should not curse this whole process across the country, because it achieves a difference in outcome in different parts of the country. We should be prepared to look at each on its own merits and judge them accordingly.

John Glen: Is there not a real challenge to reconcile the reticence to change and adapt with the clear imperative to have new technologies and new ways of doing things that can offer a step change, which are often resisted? Consultation will not necessarily deal with that.

Richard Fuller: My hon. Friend is right. I come back to the central part of what is different about STPs: they involve local authorities. On issues such as mental health and care in the community, that voice will be heard much more clearly. Our local authorities represent our local people—that is their interest. Their voice will make a substantial difference.
I have two brief final points about Bedford to which the Minister can perhaps reply. First, our CCG is under legal direction. Will that affect local decision making? Secondly, our CCG set up a joint committee with Milton Keynes to review acute services. Is he in a position to assure me that that joint CCG will not take any part whatever in the decision processes when the result of the STP is reached?

Paula Sherriff: In common with many other Members, I have received hundreds of emails from concerned constituents about the sustainability and transformation plans and what they mean for the NHS nationally, regionally and locally. To provide some local context, my constituency covers an area that sits largely in the middle of two health trusts: the Mid Yorkshire Hospitals NHS Trust and the Calderdale and Huddersfield NHS Foundation Trust. There are four clinical commissioning groups: North Kirklees, Wakefield, Calderdale and Greater Huddersfield. We are in the borough of Kirklees Council, which serves a population in excess of 430,000.
The Mid Yorkshire trust is in the advanced stages of reconfiguration—or downgrade, as many people, including myself, see it. Dewsbury hospital will this week lose its consultant-led maternity unit, and there will be changes and reductions in services for acute surgery, gynaecology and paediatrics. Next spring, the A&E department will be reduced to an urgent care centre with no provision for acute services.
On the other side of my constituency sits the Huddersfield Royal Infirmary. The Greater Huddersfield and Calderdale CCGs have just completed a so-called consultation on their “reconfiguration of services”—or, once again, downgrades. If the proposals are accepted, the infirmary will have its A&E department downgraded and the whole of Kirklees, which includes all of my constituents, will be left without full A&E provision. That is over 430,000 people who will have to travel outside the borough to access vital emergency healthcare for themselves and their loved ones.
Kirklees is a vast geographical area that spans many towns and rural and semi-rural areas. Many people there rely solely on public transport as a means of travel, and parts of the borough are in the top 10% of the country’s most deprived areas, which brings about huge health issues and inequalities. The cuts to services are not improving life chances or enhancing healthcare provision; they are purely part of a cost-cutting exercise that could result in lives being put at risk. It has been reported just this afternoon that a senior representative from a local CCG has commented that it is almost as if NHS England is putting money before quality.
We now learn that the Government have set up STPs to look at health services on a larger footprint. Some might say that is akin to shutting the stable door after the horse has bolted. How can these STPs work, given that we are so far down the line already? The reconfigurations and downgrades that have been developed are being implemented completely in isolation from each other, with no regard for the wider population or the geographical boundaries that they cover. How can the STPs work—unless, that is, they have been put in place simply to implement further cuts to our already overstretched NHS services?
Sadly, we on the Opposition Benches have to acknowledge that our NHS is in crisis. We are genuinely fearful for the future of health provision in our country, and that fear is shared by many health experts. The British Medical Association has said that
“one of the key aims of STPs is to achieve financial balance by 2020”,
and that it has concerns
“that this will be the priority for STPs rather than developing the best models for patients.”
The King’s Fund has said:
“Our assessment of draft plans shows that, in the absence of eye-watering efficiency improvements, there will be a financial gap running into hundreds of millions of pounds by 2020/21 in most of the footprints”,
and that even with cost efficiency measures that are already being implemented,
“it will still not be possible to achieve the financial balance expected by national regulators.”
Its assessment of seeing one STP struggle to achieve its goals was that it was like
“attempting to undertake synchronised swimming against a rip tide”.
How many more years will we have to endure this, and how many lives will be lost before the Government admit that their “efficiency plans” are simply not working and that the only way fully to address people’s needs is to stop the cuts and to pledge more money to fund our NHS adequately?
A constituent contacted me this week desperately worried about a loved one who was suffering many health problems in hospital. I said to her the words that many of us have used many times over the years, “At least he’s in the right place; he’s in hospital, getting the best care”. Although I know at first hand how hard those on the front line of our health service are working and how much our incredible staff do in our hospitals, how much confidence can we have in those words nowadays? At a time of diminishing budgets and major  cuts to services, can we really have confidence that our health services are adequate to provide the best care for our loved ones?
As Nye Bevan, whom I have quoted a number of times and will continue to quote, said:
“The NHS will last as long as there are folk left with faith to fight for it.”
Let it be known that I, along with my hon. Friends, will continue to fight tooth and nail to ensure that this Government do not succeed in destroying the health service that we hold so dear.

Kwasi Kwarteng: It is a great honour to be able to speak in this important debate. We have heard some very interesting contributions, and some contributions which were, perhaps, less constructive. I will not state publicly which are which, but I would like to take up what was said by the right hon. Member for Newcastle upon Tyne East (Mr Brown), who spoke of Labour’s commitment to meeting the OECD’s health spending average in 2001.
I think it perfectly acceptable, in a discussion of this kind, to point out that in 2001 the Labour Government had succeeded in running a balanced budget for four years, more or less, and we thought at the time that we had the money to meet that commitment. Having been a member of the Labour Government, the right hon. Gentleman will recall that over the next nine or 10 years we ran consecutive deficits, and as a consequence of policy that I happen to believe was misguided in many instances, we had a deficit of £160 billion when the coalition Government took office in 2010. Given the circumstances, it was inevitable that there would be a constraint on finance, and that is something that we have to speak about.
If I recall correctly, the hon. Member for Central Ayrshire (Dr Whitford), whose speech I enjoyed very much, said that we kept talking about finance, and that it should be the third consideration. I wish it were as easy as that—I wish we could relegate finance to a subordinate and back-burner role—but I do not think that that would be fair to the country, or to our constituents.

Philippa Whitford: Will the hon. Gentleman give way?

Kwasi Kwarteng: Forgive me; I cannot. The debate is very constrained now, in terms of time.
The right hon. Gentleman talked, obviously, about the budget constraints, but he also talked about the fact that we were not spending enough money. I think that the STPs present the opportunity for a serious engagement with what all Members recognise is an ongoing problem. We have a growing population and an ageing population, and inevitably, whether we like it or not, issues of finance and resources will become increasingly important.
I am pleased to learn that local consultation will be at the centre of the draft proposal, because that is essential, and it is what our constituents want. There are two hospitals in my area; one is just outside my constituency but many of my constituents go to it, while Ashford hospital is in the centre of Spelthorne. A number of the facilities have been downgraded—it has been a difficult time—but the borough council and I, as the local Member of Parliament, always tried to explain to residents  what was driving the decisions and the changes that we sought to make, and they were broadly very understanding. I think that people throughout the country are very sensible when we explain to them and carry them with us, and that they take a measured view of health services. They realise that the old NHS of Nye Bevan and 1948 has had to evolve. I believe that they are much more open to evolution and change than many Members of Parliament.
The last point that I want to make is slightly negative. I have attended many debates of this kind—not necessarily on the health service, but on the economy and welfare—and all that I hear from Labour Members is the same old mantra: “Stop the cuts, more money.” That seems to be their sole solution to every single problem that we face as a country. It is said that to a man with a hammer, every problem is a nail. Labour Members seem to think that “Stop the cuts, more money” is the answer to everything, and I consider that entirely unconstructive. I find it very disappointing to hear no constructive ideas and no proposals for reform, and to observe no appetite for fresh thinking and absolutely nothing in the way of intellectual engagement with the real problems that we face as a nation. I find it very disappointing to take part in yet another debate and hear the same old mantra: “Stop the cuts, more money.”

Norman Lamb: I want to start by saying that I very much agree with the point made by the hon. Member for Central Ayrshire (Dr Whitford) that this ought to present a real opportunity. It has brought people together, and discussions have started across organisations that in the past have not talked to each other nearly enough—both across the health and social care divide, and also bringing in people from outside the health service and social care system—but I fear that the opportunity will be fatally undermined for three central reasons.
First, there is the point that I made in my challenge to the Minister, on mental health: unless every STP addresses the burden of mental ill health in every community centrally as part of its plan, it will fail. There is no doubt about that. I noted the Minister’s attempt to reassure me, but the parliamentary answer I received recently did not reassure me, because it appears that it is not going to be a requirement that every plan must centrally address this problem. I understand that the more developed plans will do so, but if this is not done, it will absolutely fail. We are dealing often with some of the people who are failed most by the system, and who use A&E departments more than any other people, yet my fear is this will be a massive missed opportunity in that regard.

David Mowat: I thank the right hon. Gentleman for giving way, because I want to make the point again—I will say it very clearly—that if an STP does not come forward with very clear plans as to how the mental health and dementia programmes are going to move forward quickly, it will not go ahead. That cannot be clearer.

Norman Lamb: I am grateful to the Minister for that, and I hope that that message goes out across the country,  because Andy Bell from the Centre for Mental Health today has again raised concern about the process in many parts of the country.
The second issue that causes me very real concern is the financial backdrop and the ability to deliver on the plans given the finances that are available. We have already heard that the bulk of the money that is available is going into clearing the deficits of providers, rather than into the transformation that is so necessary in order, as the hon. Member for Spelthorne (Kwasi Kwarteng) made clear, to spend money more efficiently and effectively in delivering care for our communities.
Chris Ham, chief executive of the King’s Fund and a well-respected commentator, says that its assessment of the draft plans
“shows that, in the absence of eye-watering efficiency improvements, there will be a financial gap running into hundreds of millions of pounds by 2020/21 in most of the footprints”—
not across the country, but in most footprints. This is completely unachievable, and he questions the deliverability of plans which include the closure of cottage hospitals in many areas—the very things that can keep people out of acute hospitals, yet we are planning in many areas to close them down. This seems to me to make no sense at all.
There is a related concern about governance. Currently in the NHS we regulate organisations, not systems, so within an STP footprint every organisation still has to focus on its own financial survival, rather than looking at the best approach for the entire health and care system in that locality. I fear that that in itself will be a central flaw.
Finally, there is the question of openness and transparency. I note the point that there will be a consultation process, but let me just tell the Government that if they really think that a formal consultation process after full draft plans have been produced in a secret process will in any way convince the public that they are being properly involved, it will fail. It is inevitable that it will fail. People are so suspicious of consultation processes that they simply do not believe that they are being properly engaged in them.
The hon. Member for Spelthorne made a good point: people are often prepared to go on a journey. They are prepared to listen to potentially radical changes and potentially to use money more effectively, but the only way they will do that is if they are involved from the start—involved in shaping the proposals, rather than responding to something that has been fixed behind closed doors. The hon. Member for Bedford (Richard Fuller) knows full well how the public react when they are presented with what looks like a fait accompli. If the public are not involved in the development of plans to close cottage hospitals, to slim down acute hospitals and to merge hospitals around the country, we should be in no doubt that those plans will be rejected. The Government will be facing a political disaster if they plough on in this way. They must, for example, open up and involve the non-executive directors, who have been told that they cannot even be part of the discussions. That is ridiculous. For goodness’ sake, if we are to take people with us, we have to take them on a journey, engage with them and involve them in the plans.

Matthew Pennycook: rose—

Norman Lamb: I will give way very briefly to the hon. Gentleman—[Interruption.] I am being given a clear signal by Mr Deputy Speaker that I should not—

Lindsay Hoyle: Order. You have only 30 seconds to go.

Norman Lamb: I take your point, Mr Deputy Speaker, and I am sorry for my ill discipline.
I will conclude by saying that this is the right approach but it will be undermined because of the rushed process which does not involve the public, because it does not take people with it on the journey and because there is not enough money to deliver the transformation that is required.

Several hon. Members: rose—

Lindsay Hoyle: Order. I am dropping the time limit to four minutes in order to get everybody in.

Jason McCartney: I value our wonderful NHS, having volunteered again this summer in my local community hospital, and I should like to put on record my admiration for all the wonderful staff who provide great care, free at the point of delivery, in our communities. Every day, our NHS is performing 4,400 more operations and seeing 2,500 more people in A&E within four hours than it did in 2010. NHS spending in England is going up by £10 billion in real terms by 2020-21, of which £6 billion will be delivered by the end of 2016-17. Despite this, however, many communities are seeing big challenges, and it was really good to hear the calm, rational and knowledgeable comments from the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Totnes (Dr Wollaston) on that subject. As a result of those challenges, many of our communities are facing the reconfiguration of local services.
I want to speak briefly about my proposed local reconfiguration. My local clinical commissioning group is planning to downgrade the A&E department at Huddersfield royal infirmary, a hospital in my constituency. A huge community campaign called Hands Off HRI is supported by the local community, local MPs of all parties, local councillors and local GPs. If the downgrade happens, Huddersfield will be the biggest town in England without a full A&E, and patients needing A&E in our growing university town will have to travel all the way to Calderdale hospital along the notorious Elland by-pass.
On 25 May at Prime Minister’s questions, when the then Chancellor, my right hon. Friend the Member for Tatton (Mr Osborne), was taking questions, I asked him about this reconfiguration. He said that any decisions
“must be based on clear evidence that they will deliver better outcomes for patients.”—[Official Report, 25 May 2016; Vol. 611, c. 534.]
He also said that these decisions by local clinicians would have to meet four key tests, and I want to update the House on how we are doing in that regard. The first test is that the plans must demonstrate public and patient engagement. However, the results of the official consultation show that some 80% of the Huddersfield  people who completed the survey said that the plan would make the care they receive worse. The second test is that the plans must have the support of GP commissioners. Okay, the commissioners on the CCG are proposing this change, but the Kirklees local medical committee, which represents 200 local GPs, has said that local resources should be developed instead and that this controversial plan should be dropped.
The third test is that the plans should be based on clinical evidence. I am pleased to say that the recent Care Quality Commission report gave the A&E departments at Halifax and Huddersfield good ratings, but the consultant-led maternity unit, which was centralised at Halifax nearly a decade ago, was rated as requiring improvement. The fourth test is that the plans must take account of patient choice. It is clear that patients want the millions of pounds that would be spent on a new planned care hospital in Huddersfield to be used instead to improve and safeguard existing local A&E services.
I am really not interested in the partisan politics of this. I am standing up to focus on fighting to save my local A&E unit. I really believe that patients should come first. In finishing, I have one question for the Minister. I am hearing that the STP plans for West Yorkshire will be released on 21 October, the day after my CCG makes its decision. How will that impact on the future for a full A&E department at Huddersfield royal infirmary?

Kate Hollern: I have serious concerns about the lack of transparency in the process. If there had been more consultation, it would have been far more transparent. The plans’ only aim is to fit funding, rather than to examine and improve services.
Hospitals are under huge pressure in Blackburn and the surrounding Pennine area—as I am sure you are aware, Mr Deputy Speaker—with the closure of the A&E at Chorley hospital. Coupled with the huge burden facing local authorities, the Pennine Lancashire health authority has the challenge of finding £238 million over the next five years. With the best will in the world from local authorities, NHS trusts and communities, I fear that the change will not be for the better under that kind of financial pressure.
Let us not forget the savage budget cuts that local authorities have faced. Blackburn with Darwen Council alone has already had to cut £100 million from its budget, with another £48 million to cut by 2020. I am not opposed in theory to a system approach of hospital trusts and local authorities working together. In fact, that was always one of our main aims during my many years as leader of Blackburn with Darwen Council, but it was used to improve services. It is not fair that that council has effectively been handed the task of improvement with vanishing resources.
The exemption of adult social care from STPs has caused concern in local authorities across the country. It is not helpful that they have been told to leave that bit out of their submitted plans because it does not quite fit in with the budget. That will certainly not produce a more efficient and better service. The funding gap in adult social care is a real crisis that local authorities must face, but no remedy to fix it is currently forthcoming. Many pressure groups, experts and even the chief executive of NHS England, Simon Stevens, have publicly advised  the Government to make extra funding available for social care, yet the Government have been silent. They have made no commitment to make additional funds available in 2017 to support adult social care. I would like to give them an opportunity today and will happily give way to a Minister if they are prepared to clarify that point. Will the Government make additional funds available to ease the burden on adult social care, leading to better transformation of services?
Like many of my constituents, I seek clarity on whether additional funding will be made available, because if it is not, STPs will fail miserably. If we really want a transparent process and improved services, before we move on to transformation I suggest that my colleagues and I are at least made aware of what the plans contain or are assured that resources will be available to stabilise NHS and local authority services.

Helen Whately: I welcome the new ministerial team to their places. I also welcome the shadow Secretary of State, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), but can we have a more constructive debate about healthcare in future? She should not talk about cuts. She knows perfectly well that this Government will be putting an extra £10 billion a year into the NHS by 2020. That is not a cut. That is £10 billion extra of taxpayers’ money. Will she please not mislead people by talking about cuts? As she well knows, her party did not commit to spending anything like that on the NHS.

Lindsay Hoyle: I do not think that an hon. Member would try to mislead another. That is not a word that we would use.

Helen Whately: My apologies, Mr Deputy Speaker. I did not mean to use that word. The hon. Lady mentioned the £22 billion shortfall set out in the five year forward view analysis, so will she clarify whether her party is now planning to make that up? If so, where will it find the money from? That was not entirely clear in her comments.
I will move on, because I sincerely believe we need a far more constructive debate about the real challenges the NHS faces and how to improve the care it provides to our constituents. The NHS is under pressure—no one here is denying that. I know it as well as anyone, as my grandmother spent five of the last six months of her life recently in hospital, and if the system had been better she would not have been there and would have had a much better end to her life. We know that people are living longer, with multiple conditions: about 70% of NHS spending goes on dealing with long-term conditions. The treatments available have increased vastly and are therefore more expensive than they were in the past, and patients expect far more of the NHS.
The NHS should not constantly be criticised, as is so often the case, as it is seriously rising to the challenge. It is performing thousands more operations, with thousands more patients being seen every day. In addition, in response to what happened at Mid Staffs and other such incidents, tens of thousands more doctors and nurses are working in the NHS. Skilled staff do not come about overnight; training takes years. A lot is therefore being done also to address the pressures on the NHS workforce. None of that should be overlooked, although it is also costly.
I ask us all to focus on talking about how the NHS rises to the challenges it faces, doing so in a financially sustainable way. We do not have a blank sheet of paper for this; The “Five Year Forward View” was published in 2014. As you may well know, Mr Deputy Speaker, I have previously asked questions about what was happening to drive forward that review at the pace and scale needed. The STPs are a vital part of the process, as across the country they are about putting the five year forward view into practice. They are doing that in an important way, looking at the place and the whole population, bringing together a diversity of organisations across the NHS and involving local authorities. We are talking about organisations that are rarely in the same room. In Kent, organisations have come together where previously people have literally not spoken together—chief executives have not previously been in the same room together. This is really important. The STPs are also putting public health at the core of the future plans for health and care across the region, and they are looking not just at treatment but at how the population can be healthier and how we can reduce health inequalities.
Finally, I urge all colleagues to do what I am trying to do, which is make sure that the STP in their area rises to the challenges and delivers the care that we all want for our patients in future.

Peter Dowd: A recent report to my local health and wellbeing board on STPs stated:
“There is a growing consensus that one of the most powerful ways to achieve change is through local services working together—across entire communities and pathways of care—to find ways to close the gaps between where we are now, and where we need to be in the future.”
That was the hope of the many people who have written to me on this matter. I really appreciate the time they have taken to share their concerns with me, but I can give them little comfort as things stand. Regrettably, in my area the “footprint” is an area in Cheshire and Merseyside, not in the Liverpool city region. That was determined unilaterally by the governance structure and it is regrettable, getting the process off to the wrong start, with the suggestions of local political leaders dismissed. That act has compounded the problem, in that they are the very people the NHS should be consulting: local communities, the leaders of councils and local councillors. These are the democratically elected representatives in those areas.
This move is all the more disappointing given that there is a council leader who has responsibility for the health and social care brief across the city region. It is more than disappointing—it is bizarre, especially as local government is supposed to be a significant partner of the NHS. The Government have pushed the issues of health and social care integration no end, but it seems more in theory than in practice. NHS England can hardly put out a press release without mentioning it, yet I suspect that many health footprints are in the same situation as those in my constituency. There is no doubt that people are being excluded. I have emphasised this issue because it goes to the heart of the willingness of the NHS to step out of its self-imposed bureaucratic mindset. Worryingly, though, it appears to have an almost pathological inability to break out of it.
In my area, it is a case of going back to the past. The default position of my local NHS is to reinstate the old Cheshire and Merseyside health authority areas. My message is to stop and think. We are in the 21st century, not the 20th century. The reality is that the democratic lack of accountability in the NHS, certainly at a local level, leads to an inability to recognise that, in setting the terms of engagement with local community partners, it must do so before decisions are made, not after.
As far as I am concerned, the Government are telling us that all is well, that they have poured loads of money into the NHS and that there is enough in the system, so it is just a question of making better use of it. Yet the Germans spend 40% more per head than we do, and across the European Union the figure is 25%. People take the Government’s claims with a big pinch of salt, as all they see are waiting lists growing longer; ready access to their GPs becoming increasingly difficult; waiting times in A&E growing by the day; ongoing industrial disputes with junior doctors; and GP-led clinical commissioning groups beginning to start the process of rationing. And so it goes on. We need an NHS that has the consent of our community and an NHS that links in with communities. In this respect, I fear that the plans will turn out to be neither sustainable nor transformational, which will send the message that the NHS is not safe in Tory hands.

Maria Caulfield: Before I start, I wish to declare an interest as a registered nurse. I welcome this debate this afternoon as STPs are a really important issue and, as many Members have said, they have a huge potential to transform care at a local level, bringing in social care and third sector organisations. They represent a huge opportunity, and not one that we want to get wrong.
However, because many of these 44 STPs have not shared or consulted on their plans, there is a suspicion, rightly or wrongly, that they are an excuse to bring in cuts or to bridge financial deficits. I would welcome the Minister’s thoughts on this, and a signal that consultation will happen. That consultation is not happening at the moment, which is part of the problem. It enables those who want to perpetrate this myth and this fear that this is all about cuts to have some breathing space.
My area, which falls into the Sussex and East Surrey STP, has not published its STP. Although it makes great claims to be working with hospitals, clinical commissioning groups, local councils, GPs and HealthWatch, no one I know, and certainly no local MPs, has been involved in discussions about the process. I am very disappointed that some of our key community groups in Lewes and Seaford, such as our senior forums, Families for Autism and many other groups have not been consulted. It is right that STPs should submit their plans to NHS England to ensure that there is a co-ordinated approach across the country, but it is vital that there is time for consultation. I am worried that there is only a short period after October for that to happen.
However, what I say to the doom-mongers who are trying to instil fear into my constituents is that if current investment is anything to go on, I am optimistic about what our STP will look like. My constituency  does not have a hospital. We depend on either the Royal Sussex county hospital in Brighton or Eastbourne district general hospital. We are seeing huge investment by this Government: £480 million on a new redevelopment of the Royal Sussex county hospital; £58 million promised for Eastbourne district general hospital; and a new multi-million pound radiotherapy suite at Eastbourne. Only last year, a new dialysis unit was opened in Polegate, which means that patients do not have to travel to Brighton three times a week for dialysis. Working with my hon. Friend the Member for Eastbourne (Caroline Ansell), we have been involved in developing a new state-of-the-art GP practice surgery in Eastbourne. There is a new Macmillan cancer centre in Sussex, and I could go on. There has been huge investment and new services that provide local treatment for local patients.
With all this investment, why are local people so worried about cuts? Despite an increase of £10 billion a year in funding, the NHS has to deliver £22 billion of savings. My constituents know that there is a 6% a year increase in demand for services, that more treatments are available that are costly and that there are more conditions that can be treated. There are concerns that we have not tackled wastage in the NHS, such as in the case of the chief executive of the troubled Southern mental health trust who was offered £240,000 for a new job instead of being investigated for the many hundreds of deaths that happened while she was in her previous role.

Mims Davies: To be efficient and effective, the NHS must stop these non-jobs. The creation of highly paid advisory roles is not helpful in letting patients be heard in this process, yet executives are heard, in terms of being given new offices and new paychecks.

Maria Caulfield: Absolutely, and £240,000—

Natascha Engel: Order. Andy Slaughter.

Andrew Slaughter: I hope that I am in a position to assist some of the Members who feel that they are in the dark or confused about what is in their STPs. That is not because my own sub-region, north-west London, is one of the two, I think, that have officially published their schemes—I fear that, like most NHS documents, it is written in a style and language that make it difficult for the ordinary public to understand. Rather, it is because, for north-west London, this process has not mushroomed overnight, as has been the case with STPs generally, but has been developed over four years. In the wonderful Orwellian language that is used, we have had something called “Shaping a Healthier Future” since the middle of 2012, and that has simply morphed into the STP, so I can perhaps give a little insight in the few moments that I have.
What did “Shaping a Healthier Future” mean? It meant the loss of 500 acute beds. It meant that of around nine major emergency hospitals two would, effectively, be downsized to primary care, and four A&Es would lose all their consultant services—and that, as far as I am aware, is still the plan. What has become clear with the transformation into STPs is that this is very much about money. The original language  four years ago was that unless we implemented these cuts to acute services, we would “go bankrupt”. When that language did not go down very well—not surprisingly—with the 2 million people affected in west London, the language changed, and it was all about clinical care.
I am pleased that at least the honesty is now back in the system, and the proposals are now very much about money. One sees why when my own hospital trust—a very important, prestigious trust called Imperial, which runs three major hospitals—is over £50 million in deficit this year alone. The CCGs are flatlining on funding. The importance of that is that the only possible justification for these major cuts in acute care is that social care, community care and primary care funding will be increased. How that is possible with budgets that are, at best, standing still, I really do not know.
The other interesting factor is the delays that have occurred over this time. We had this proposal in the middle of 2012 and a slight revision in February 2013—and then silence. I have lost count of the number of times I have been promised that a full business case will be published. I act as the unofficial shop steward for the 11 Labour MPs in the sub-region, and I summoned them all to a meeting and said, “You’re going to get the business plan this month.” It was going to be next Tuesday, and we were all coming in in the recess to look at it, but, guess what, it has been put off until at least after the new year.
Moreover, the plan is now thought to be so unwieldy and so difficult to achieve that it has been split in two. My own hospital—Charing Cross—was due to lose 90% of its acute beds and its consultant emergency services, and we simply do not know when the proposals will now be published, but it has already been taken outside of the STP process. In other words, it is beyond the five-year horizon, and nothing will happen until 2022. Now, in one way, of course, I am delighted that the demolition balls are not going into Charing Cross for that period, but in the meantime the lack of support the hospital is getting worries me greatly.
These STPs are a Trojan horse for cuts. They are about cuts in acute services before there are compensatory services. For that reason, Members should be extremely concerned and worried about them, and I am happy to share my pain and knowledge on the subject if any Members wish to hear about them.

Several hon. Members: rose—

Natascha Engel: Order. Before I call the next Member, let me say that the person after the next speaker will go down to three minutes, and I encourage no interventions in order to get everybody in.

Simon Hoare: There are two things that we need to nail before we go any further. I listened to the Castro-esque monologue of the shadow Secretary of State, who prayed in aid the King’s Fund. She refused to take an intervention, but I was keen to ask her why she was not quoting the King’s Fund when it described privatisation in the NHS as a “myth”. Considering that the Conservative party has been in government for the longest time during the existence of the national health service, if we wanted to privatise it,  frankly, we would have done it by now. All Conservative Members, like all Labour Members, are champions of the NHS, determinedly and doggedly trying to ensure that our constituents have the very best healthcare.
I am also slightly incredulous about the “wanting to have the penny and the bun” approach that Opposition Front Benchers have advocated. They want to see greater transparency in the process, as we all do, but as soon as there is the whiff of an idea coming through in consultation, up they get with their shrouds, running around saying, “This is closing, everybody’s going to die, rickets is coming back.” It is therefore perfectly understandable, though regrettable, that, rather like a snail, those who are trying to think about changes retract further into their shell.
One idea for the Minister—I hope, Madam Deputy Speaker, that this will not be ruled out of order—is that if we want to improve sustainability in healthcare and the health service, we should be taking advantage in our soon-to-be-free Brexit world of being able to have across the health service, through our procurement process, entirely British-made and produced foods and milk. That would certainly add to sustainability. I say this on the National Farmers Union’s Back British Farming day, and as a DEFRA Parliamentary Private Secretary.
As my hon. Friend the Member for South West Wiltshire (Dr Murrison) mentioned, there are problems afoot in my constituency with regard to the Westminster Memorial hospital at Shaftesbury, a popular and useful community hospital. This is causing enormous concern among my constituents. I for one, once as a district councillor and now as a Member of Parliament, firmly support and champion the provision and continuance of our community hospitals. They provide a very useful spoke in the healthcare framework in providing the transition from the acute sector, where there is often pressure on beds, right the way through, one hopes, to patients returning to their homes. I ask the Department to think about this. Often the word “consultation” is used when what is meant is “information”, and scenarios are not put forward. The public are not stupid. They need to know what happens here if they choose this option, and what happens there if they choose that option. I hope that even at this late-ish stage we can have some clearer guidance from the Department about how to go about consulting the population to make sure that they buy into these proposed changes.
I am keeping an open mind about the plans for healthcare across North Dorset. We cannot just close the door to innovative thinking and the need to meet modern clinical demands. Patient care must come first, although that cannot be a defence in order to try to avoid change and challenge in service provision. I hope that anchored in the Dorset plans for healthcare is a very clear role and place for our community hospitals, particularly in Shaftesbury.

Paul Farrelly: This so-called transformation process has been going on in fits and starts in Staffordshire since 2014. By 2020-21, the deficit will be £347 million, including social care, according to the draft STP presented behind closed doors in Whitehall in July. The Secretary of State has  refused to publish that plan, of course, but what is important is that the menu being cooked up behind the scenes is already being dished out in practice, with no meaningful public consultation, playing fast and loose with NHS guidelines. It is being driven by cost-cutting, bullied through by NHS England, not rational planning for better integrated care in the future, even if that means that, in the short term, the pressure on patients is increased, particularly at our local Royal Stoke University hospital, where the wretched sight of trollies queuing up in A&E corridors is now commonplace.
Before the summer, the closure of ward 4 at the local Harplands hospital took away a safe place of discharge for patients with mental health problems. Cuts to the county’s better care fund threaten the viability of drug, alcohol and other services, as well as respite and rehab facilities such as those at Brighton House in Newcastle. Last month, we learned that both wards at Cheadle community hospital will close, further affecting discharges, while social services struggle to cope. Children’s A&E at Stafford has shut, and last week staff at Newcastle’s community hospital, Bradwell, learned that three of its wards are to close this winter or next spring. As a result of all that, the pressures on our local acute hospital will simply continue to multiply.
As a county, Staffordshire does not fit together as a healthcare whole. While the north and west look to Stoke, the south engages with Birmingham, Wolverhampton and even Worcester, and the east with Derby. Rather than plan integrated care along those pathways, I understand that a county-wide merger of everything is now on the cards. That monolith has been called, with no sense of irony, an accountable care organisation, yet the health and care transformation board has been anything but accountable so far, not least in relation to the pay that senior executives are raking off from this process.
The parachuted-in programme director, Penny Harris, is being paid a salary of £168,000 a year for a four-day week, and her deputy, Sarah Carter, is on £172,000 for a five-day week. The lead finance officer, Neil Chapman, is on £244,000 a year. Add in two other people on the Staffordshire board who are on £131,000 and the annual bill for just five of them comes to £846,000. Another £675,000 is going to KPMG, which means that more than £1.5 million is being paid by the local NHS. These people, quite simply, are devouring what is left in the pot for transformation.

Antoinette Sandbach: I am delighted to be able to speak in this debate.
Two hospitals serve my constituency, namely the Countess of Chester hospital and Leighton hospital, which is actually in my constituency. There are going to be pressures on Leighton hospital: the clinical commissioning group is indicating that it may cut its funding, despite an increase in funding to the four local CCGs that serve my constituency.
I was surprised by the speech made by the shadow Secretary of State, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), because the big pressures on health in Cheshire are a result of the slash-and-burn tactics adopted by Labour in Wales. It is a case of, “Do as I say, not as I do.” Labour’s actions over the border in Wales have had an impact on health  services in Cheshire. It has cut the health budget—it has not even kept pace with inflation—and downgraded a huge number of hospitals. It has closed almost all the community hospitals, and it had suggested that some patients would need to drive for more than two hours to access maternity wards. One of those hospitals would have been the Countess of Chester—it would have had to have served a huge rural hinterland—and it is not in Wales, so I take no lessons from the Labour party when it comes to transformation plans. Labour’s actions in Wales mean cuts, the downgrading of services and worse access to care than the current positon in England.
I agree with the hon. Member for Central Ayrshire (Dr Whitford) that the transformation programme provides huge local opportunities, including to form tailor-made plans that will suit local populations, particularly in Cheshire, which has large rural populations. The opportunity to deliver more services in a primary care setting should be welcomed.
On funding for social care, I welcome the fact that changes in the budget mean that additional funding from council tax receipts will go to local authorities to help with their social care budgets. To that extent the involvement of the local authorities, Cheshire West and Chester, and Cheshire East, in the transformation plans, and in particular the integration of social care and health services, provides an opportunity which I hope the STP in Cheshire will seize.

Ruth Cadbury: I draw attention to my entry in the register of interests. My husband is a non-executive board member of Chelsea and Westminster Hospital NHS Foundation Trust.
Like many Members, I have had a very large mailbag about today’s debate because so many of my constituents rely on the NHS to keep them and their families in good health, and they want the NHS to carry on providing good, appropriate services that are accessible and timely, and free at the point of entry. They want funding not only to address the deficit, but to invest in improvement of services. Those who work in the NHS care deeply about its future and want to be able to do their best for their patients.
Like the constituents of my hon. Friend the Member for Hammersmith (Andy Slaughter), people in my constituency are deeply concerned about the future of Charing Cross hospital—a large general hospital with a busy A&E department in the neighbouring seat which serves many of my constituents. The hospital’s future has been uncertain for at least five years, since the north-west London NHS first proposed closing A&E there and in four other north-west London hospitals.
People are extremely worried about the travel times from Chiswick to the nearest A&E, about the inevitable downgrading of the other services on that site once A&E goes, and about the capacity of neighbouring hospitals to cope with the inevitable additional pressure. The issue has been ongoing for a while for us.
The STP comes at a time when we have a £1 billion funding gap in north-west London. It is proposed to close 500 beds and a 40% cut is proposed in face-to-face consultations. This is against a background of rising population and increased health needs and in the context of our services currently missing many targets.
Social care cuts are crucial to the argument. How can STPs have any credibility if the NHS cannot plan nationally when the other main services relevant to people’s long-term health are funded and controlled in a different place and in a different way and are being cut and cut and cut?
The north-west London STP, as I said, proposes cutting beds. We all want treatment to be less dependent on spending nights in hospital beds, and some reduction in acute beds is inevitable with changes in modern health provision, but 500 beds is a staggering number proposed to be cut in west London, where the population is rising and ageing.
I will end by responding to Members on the Government Benches about the funding gap in the NHS. The NHS would not have a funding crisis if this country matched the health funding per head of similar countries. The King’s Fund has shown that the UK public purse spends a smaller proportion of GDP on healthcare than countries such as Portugal, Japan and the Netherlands. If those countries value health in this way, surely so can the UK.

Jeremy Lefroy: First, I would like to place on record my thanks for the tremendous work of NHS staff throughout the country, in particular NHS staff in my constituency and the constituencies of other Members in Staffordshire, at the County hospital, the Royal Stoke hospital, GPs surgeries and so on. They have done a great job over the past five or six years when our health economy has been in the national spotlight.
Of course, we have had out own sustainability and transformation plan since 2012, with the trust special administration of the Mid Staffordshire NHS Foundation Trust. It was an extremely difficult and challenging time and I want to draw out two points from that. The first was eloquently made by the right hon. Member for North Norfolk (Norman Lamb)—the vital importance of consultation at every level. Do not leave people in the dark. There is nothing that my constituents like less than finding leaked reports and things that they are supposed to know about that they do not know about. Please keep as much in the public domain as possible. No doubt there will be plans that arouse anger and hostility, but it is better to deal with that properly and in public. That is what we discovered.
The second thing I want to say is: “Stick to what you agree.” What the trust special administrator for Mid Staffordshire came out with was not what we wanted. In fact, it was far short of what we wanted, although it was better than the minimum that was proposed at first, largely as a result of our local campaign. We have just had, as the hon. Member for Newcastle-under-Lyme (Paul Farrelly) mentioned, the temporary closure of our children’s emergency centre on safety grounds. That centre was specifically committed to in the trust special administrator’s proposals, and it only opened a year and two months ago. It must be brought back immediately, or as soon as possible—that means in the next few weeks—because it was a commitment. Commitments that come out of the STPs must be met.
The final point I want to make, following on from what others have said, is that we spend too little of our GDP on health. Even The Economist, as it made clear  in an article last week, says that we need to spend a higher proportion of our GDP on the NHS. That means raising the money; in my view, we should do so through higher rates of national insurance in the long term. My hon. Friend the Member for Salisbury (John Glen) and I wrote an article about this a couple of years ago, in which we recommended a hypothecated tax. I believe that that is still an important way forward. As others have said, the STPs offer a good opportunity to go forward and make necessary changes, particularly around health and social care, but STPs that do not look beyond 2020 at the percentage of our GDP that we spend on health and social care will not succeed.

Barbara Keeley: The Nuffield Trust has said that the sustainability and transformation plans could lead to
“fundamental changes in the shape and nature of health and care services.”
As we have heard in this debate, despite the significance of the plans, there has been very little opportunity for patients, the public, NHS staff or Parliament to scrutinise them. The BBC has seen draft STPs that propose ward closures, cuts in bed numbers and changes to both A&E and GP care. The Nuffield Trust, which has examined the STPs, sees the same possible changes plus a questioning of the role of community or cottage hospitals, which Conservative Members have referred to. Those are the reasons why many people, including my constituents, are concerned about the lack of consultation on the plan.
In greater Manchester, the devolution document “Taking Charge”, which was published last year, is being used as the basis for the STP for Greater Manchester. It outlines the need for integrated health and social care, and reform plans for cancer, mental health and a number of other services. Our health and social care partnership believes that it made significant efforts to reach out to local people with the “Taking Charge” document, but when I looked at it I found that actual number of people who were definitely reached was quite a small proportion of the 2.5 million population of Greater Manchester. A number of information booklets were sent out, there were 200 meetings and 6,000 people completed a survey, but we have 2.5 million people living in Greater Manchester.
The document does not include detailed plans about which services will be changed or any cuts that will be made in Greater Manchester under the STP. The document does outline savings totalling £1.5 billion—including from things such as prevention, reform of NHS trusts, productivity savings and joint working—but it provides no detail about how that will be done.
The health and social care partnership board is now finding a number of gaps that need addressing, including in the delivery of the nine “must dos” in the five-year forward view. As with savings, decisions about how to deliver those “must dos” are bound to have a significant impact on existing local services. The financial situation of our health and social care sector is, to me, one of the most important issues. I am concerned that the Government are passing the buck to local authorities and NHS trusts, leaving them to make plans without sustainable funding.
In Greater Manchester, as the Minister probably knows, we have revised down the size of the funding gap to £1.75 billion, but that is still a very significant financial challenge for our area. There are plans to centralise mental health, pathology and radiology, but what will it mean? Will services close? Those are the sorts of decisions that local people are entitled to know about before the STPs are signed off. We have an opportunity in Greater Manchester to tailor services to local needs, but that opportunity for positive change will be lost if we do not have a more sustainable financial model for our health and social care services.

Ben Howlett: It is a pleasure to follow some very hard-working and committed campaigners on health issues, particularly my hon. Friend the Member for Stafford (Jeremy Lefroy), who has done so much to champion the NHS. I join him in thanking all NHS staff members across the country, who work incredibly hard day in, day out. A lot of them do not get the thanks they deserve.
Compared with some Members, I have had an very good range of consultation exercises with my clinical commissioning group on the STPs. The group has engaged with MPs not just in Bath and north-east Somerset, where the Royal United hospital is located, but across Wiltshire and Swindon. If the ministerial team are looking at examples of best practice, I am more than happy to host them and the group on STPs in Bath and north-east Somerset to show them the work being done to engage thoroughly across the entire patch.
I am incredibly pleased to speak in today’s debate, because Bath has a range of very difficult niche concerns about healthcare—not just the ageing population, but the fact that in a city such as Bath with have not only one in five children living in poverty, but some of the highest levels of alcohol and substance misuse in the south-west, a fact which is often glossed over. The STPs will provide an excellent framework for tackling some of these issues, which have not necessarily been tackled previously. I am also incredibly pleased that the Minister will look at the idea of changing the funding formula in the NHS so that people who need more should get more. Unfortunately, the NHS has not necessarily been able to provide the funding that it absolutely needs to carry out reforms.
I fear that huge misconceptions and a lot of scaremongering have arisen from this debate. Unfortunately, that is harming what is likely to be an incredibly positive policy, which has been required for many years. In Bath, we want to work with Swindon and Wiltshire through the new sustainability and transformation plans, as well as with neighbours in other areas as well. Will this be a constantly evolving project, because as devolution is created throughout the UK, the plans will sometimes need to be changed to make sure they fit the new footprint as devolution comes into force?
In such debates, it is incredibly important to stand up for what one’s clinical commissioning group is asking for. I would be failing it if I did not say that, although this year the finances have been okay, the projected finances for next year will be incredibly difficult. We need funding to match the plans. I think everyone in the House agrees that we must ensure that funding matches the requirements of local communities.

Margaret Greenwood: To understand the significance of the Government’s creation of the sustainability and transformation plans, we need to be aware of what has gone before and consider the extent of the financial crisis. In 2012, the coalition Government passed the Health and Social Care Act, paving the way for the privatisation of the national health service and removing the duty of the Secretary of State to provide and secure a comprehensive health service in England. I believe the STPs are a key part of the Government’s plan to drive through privatisation.

George Howarth: Does my hon. Friend agree that the concern in our part of the world is that the word “sustainability” is all about financial sustainability, not the sustainability of services?

Margaret Greenwood: My right hon. Friend has hit the nail on the head.
Monday’s Liverpool Echo leaked some of the detail of Merseyside and Cheshire’s STP, reporting an anticipated £1 billion deficit by 2021. The STP talks about a
“need to reduce demand, reduce unwarranted variation and reduce cost.”
Those are all very nice ambitions, but the idea of trying to reduce demand just to plug a £1 billion funding gap is, frankly, the wrong way to deal with planning a sensible health service. The STP also says that there is an “appetite” for hospital reconfiguration—an appetite among whom, one might ask—as the existing set-up is unaffordable. It says there will be a requirement for
“our hospitals to be reconfigured, consolidated with less sites and clinicians and consultants working increasingly in new emerging networks.”
There is a problem with commas in the document, so who knows what it means. In other words, there will be cuts to staff and cuts to hospitals.

Mark Hendrick: Does that not show—it was certainly the case in the Chorley A&E closure—how this is being done by stealth? There has clearly been an increase in demand, but the support has been spread, rather than targeted at localities.

Margaret Greenwood: My hon. Friend is absolutely right.
The plan goes on to say that
“the shape and size of the hospital’s bed base will need to be reconfigured”.
In other words, there is a real threat to the number of available hospital beds we will have, and I am particularly concerned about Arrowe Park hospital in my constituency. One radical proposal is the merger of four major hospitals in the area.
Let us be clear: the STPs are vehicles for cuts. They are being devised in secret—hence the need for the local paper to leak the details—and are to be delivered by local areas at arm’s length from the Secretary of State, just as the Health and Social Care Act 2012 allows. He can just shrug his shoulders and say that it is nothing to do with him. That is absolutely not good enough.
The Government must publish the STPs in full. They must provide time and resources for meaningful consultation with healthcare workers, the public and elected  representatives, and provide the extra funding the NHS so desperately needs. Otherwise, the STPs will prove the final piece in the privatisation jigsaw, and we will see the sale of assets, our hospitals sold off, and the break-up of services, with patients having to find their way around a fragmented and dwindling healthcare system. Our hard-working NHS staff will see more and more of their jobs moving to private providers and their pay, terms and conditions being undermined. The public absolutely do not want that. They know what the Government are up to—I have had such a big mailbag on this issue. People are concerned and absolutely understand the context. There is a way around this: it is time for the Government to hold up their hands, admit that they have been rumbled and put an end to their privatisation of the national health service.

Emma Lewell-Buck: We have all become accustomed to the Conservative party’s disdain for our NHS since the shambles of the top-down reorganisation that began in 2012. Now we have the stealth introduction of sustainability and transformation plans—secret plans that would bring yet more unjustifiable and drastic reforms to cash-starved hospitals. Instead of being given the funding they so desperately need, hospitals are being asked to make £22 billion of efficiencies to compensate for this Government’s total mismanagement of our NHS. The audacity of making hospitals themselves pay the price for that by threatening them with closure or the reduction of acute services is the final act of treachery in a tragic and deliberate play to decimate our NHS.
South Shields is part of the footprint area of Northumberland, Tyne and Wear, an arbitrarily created boundary. By 2021, the health and social care system in that footprint area is projected to be £960 million short of the funds it needs to balance its books while maintaining the same level of care for patients. Make no mistake: these plans are about cuts. They are nothing to do with transforming our NHS for the better. The NHS has been set an impossible task by the Government; the endgame is to see it in private hands.
The Government have said that the initial STP submissions to NHS England are
“for local use, and there are no plans to publish them centrally”—
a nice touch to put the onus once on to our hospitals again, so that the Government themselves do not have to deal with the flak.

Rupa Huq: Will my hon. Friend give way?

Emma Lewell-Buck: I would rather not, because a lot of people are waiting to speak.
I was born in South Tyneside hospital. I am the local MP for the area, and I have not seen a single plan. Not even the governors at my local hospital have, let alone the people of Shields, whose vital acute and emergency services could be devastated by these changes.
I am told that the timetable for implementing these unseen plans begins this autumn, yet the first we will see of them in my area is at the end of this month—that is, in the autumn. I am extremely alarmed at the lack of accountability and transparency with which the plans  are being pushed through. There is simply no time at all for consultation. I make a plea to all NHS leaders not to be complicit but to stand up for their hospitals and the communities that they serve. The Government have no mandate for such a radical reconfiguration of our NHS, one that could involve the closure of accident and emergency and acute services up and down the country.
Last week, the Prime Minister called in NHS leaders to order them to stop any hospital mergers or closures that risk causing local protests. There is already a protest in my constituency.

Liz McInnes: Before entering the Commons, I worked for 33 years in the NHS and saw and experienced on a daily basis the service that it provides to millions across the UK, from its GPs to its world-leading research and development. With 80% of hospitals in debt, bed-blocking at record highs, an ageing population, waiting times for cancer treatment lengthening, underfunding of social care, mass staff shortages in hospitals and a future where collaboration with the European Union is unclear, we should show our commitment to our NHS in its time of need and give it the funding it deserves so that it can succeed for all patients.
The NHS STPs do not clearly address those issues. As many hon. Members have said, they have been shrouded in secrecy and drawn up behind closed doors. There has been no public consultation, and there is a staggering lack of evidence that they will deliver the reductions and improvements the Government promise. They will be untried and untested, and will come at an unimaginable cost to patients if they are found not to be the right path to pursue.
I am a Greater Manchester MP. When the metro mayor plan was introduced, bold promises of devolving power to the region were made, including in health.

Rupa Huq: My hon. Friend mentions local government. Is she aware that, in north-west London, which is one of the few areas not to have had its STP published, the London boroughs of Ealing and of Hammersmith and Fulham have not signed up to the STP? They are refusing to do so because it threatens the closure of both Ealing and Charing Cross hospitals. The mistrust and secrecy is everywhere, including in local government.

Liz McInnes: My hon. Friend highlights the secrecy surrounding STPs and the attempts of local authorities and the devolved regions, including Greater Manchester, to deal with devolved health issues, as they are supposed to do.
The promise to devolve health was front and centre of the Cities and Local Government Devolution Act 2016. Metro mayors would need to be consulted like any other political leader, and the plans jeopardise the autonomy of the metro mayor’s powers. The British Medical Journal states that STPs may risk the post of metro mayor
“becoming a rallying point for opposition to service reconfigurations.”
Not only metro mayors and clear legislation are needed if the STPs are to be effective. Councillors and committees must be at heart of the planning process, and health and wellbeing boards must be an integral part of it. They are the only place where local political, clinical and professional leaders come together. They can be pivotal in driving change, but they seem to have been put on the waiting list for consultation.
As with the disastrous Health and Social Care Act 2012, overseen by the former Prime Minister, and now former MP for Witney, the proposals take us on a journey to another calamitous reorganisation of the NHS. It is now a necessity that the Government abandon the timetabling and scheduling of such a major restructure package. Perhaps now is the time to step down and take stock, like the former Prime Minister. I call on the Government and Secretary of State for Health to go back and reconsider not only the timeframe but the proposals in general, and to have a full and frank public consultation, allowing for transparency and debate at local and national level.

Justin Madders: This has been a high-quality and interesting debate. I welcome the Minister of State, Department of Health, the hon. Member for Ludlow (Mr Dunne), to his new role. As he is new to the role, I will forgive him for not knowing precisely how many trusts ended last year in deficit—it is 80%, by the way. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, that is the context in which we are discussing the plans, which means that the public will rightly be cynical about them, particularly if they are presented with a final plan. The Minister underplayed their development a little when he said that they were simply ideas. If that is all they are, let us see them.
We have heard contributions from the hon. Members for Bosworth (David Tredinnick), for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston); my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown); my hon. Friend the Member for Dewsbury (Paula Sherriff); the hon. Members for Spelthorne (Kwasi Kwarteng), for Bedford (Richard Fuller) and for Faversham and Mid Kent (Helen Whately); my hon. Friend the Member for Bootle (Peter Dowd); the hon. Member for Lewes (Maria Caulfield); my hon. Friend the Member for Hammersmith (Andy Slaughter); the hon. Member for North Dorset (Simon Hoare); my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly); the hon. Member for Eddisbury (Antoinette Sandbach); my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury); the hon. Member for Stafford (Jeremy Lefroy); my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley); the hon. Member for Bath (Ben Howlett); and my hon. Friends the Members for Wirral West (Margaret Greenwood), for South Shields (Mrs Lewell-Buck) and for Heywood and Middleton (Liz McInnes). I am sorry that I am unable to refer more to hon. Members’ contributions because of the time pressures.
Let us get down to the brass tacks. This is another reorganisation of the NHS, only this time it is being done behind closed doors. It is not just a reorganisation but an admission, as if we did not already know it, that the Government got the last one wrong. The Opposition  do not need persuading that there is a benefit to more localised strategic oversight of the NHS and the health sector. We know that because we opposed the Government’s decision to scrap strategic health authorities as part of the 2012 Act.Unlike the strategic health authorities they are now trying to replace, there is no statutory basis for STPs and there is no scrutiny or transparency at all. Despite this, they are being asked to go further than any body has ever had to in the entire history of the NHS in terms of the cuts they are being asked to make. These cuts are being cooked up behind closed doors. This is happening without the involvement of patients, carers, clinicians, trade unions and staff. Consultation with the public does not mean presenting them with a completed plan as a fait accompli and asking them whether they support it. It means involving them from day one. The bigger the change, the better it is to start early with that consultation.
In my area, what has been published about the Cheshire and Merseyside plan states that it
“will require our hospitals to be reconfigured, consolidated with less sites and clinicians and consultants.”
Yes, that means fewer hospitals, fewer doctors and fewer nurses. No wonder the Government do not want to talk about it. Many Members, including the Chair of the Health Committee, have talked about the importance of consultation. We know from history that if an attempt is made to significantly alter local health services without engaging with the public and establishing local support at an early stage, it will fail. That is not just my view. This is what the Secretary of State himself said:
“the success of STPs will depend on having an open, engaging, and iterative process that involves patients, carers, citizens, clinicians, local community partners, parliamentarians, the independent and voluntary sectors, and local government”.
That just has not happened so far.
Not only are the public locked out of contributing to this process, they cannot even find out what is happening. I submitted freedom of information requests to NHS England and the 44 STPs, asking for copies of the plans submitted in June. The deadline for replies is tomorrow and so far not one has been provided to me. Many have simply refused to provide me with the plans, using the exemption that they are “intended for future publication.” When I asked the Minister when the June plans would be made available, I was surprised to read in his response that
“The June submissions were a ‘checkpoint’ and will not be published.”
We have STPs saying one thing and Ministers saying something else about whether the plans will be even published. No wonder people are concerned about what is in them.
Is this not the nub of the matter? Plans about fundamental changes to local health services have been sitting on the Secretary of State’s desk since June, but he will not release them. Surely in the interests of transparency they should be made publicly available now. There is nothing wrong in principle with the idea of local partners working collaboratively to transform health services, but there is everything wrong with doing so without transparency, public involvement or clear lines of accountability.
I welcome the new Minister, the hon. Member for Warrington South (David Mowat), to the Government Front Bench. When he responds to the debate, will he commit to dropping the secrecy and listen to the concerns  of clinicians and patients, and ask each area to make their plans publicly available immediately? Will he clarify his role in the plans? When responding to a point made by the right hon. Member for North Norfolk (Norman Lamb), he said that plans will not go ahead if they do not deliver for mental health. However, the Minister of State, in response to a written answer, said:
“The reconfiguration of services…is clinically led and a matter for the local National Health Service.”
So which is it? Who will get the final say? Will it be the Government or will it be the local STPs?
What we have seen so far is a process that has failed to engage with just about every stakeholder imaginable, but even those who have been invited to attend the meetings are beginning to lose faith in the process. Council leaders and officers are queueing up to express their concerns. We heard from my hon. Friend the Member for Bootle about how his council leader’s concerns were dismissed. The Conservative leader of Kent County Council, Paul Carter, said:
“In Kent and Medway, NHS England is doing everything it can to keep local government out of it.”
Izzi Seccombe, Conservative leader of Warwickshire County Council, said that local
government was being
“left out in the cold and not involved in the integration agenda.”
If STPs are the answer, can the Minister tell us why even council leaders from his own party are finding themselves totally disengaged from this process?
Many Members, including my hon. Friend the Member for Lewisham East and the hon. Members for Central Ayrshire and for Totnes, made the point that much of the money set aside for transformation has been spent on deficits, so let us not pretend that STPs are a panacea. Do not take my word for it; listen to what NHS providers are warning:
“We must be realistic about what STPs can achieve…and what they can deliver in terms of the £23 billion efficiencies required. It should not be overestimated.”
Nigel Edwards, of the Nuffield Trust think-tank, says:
“I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap.”
Given the warnings we have already heard, will the Government seriously engage with the health service on the challenges they face, or will they continue to insist on impossible targets and unrealistic timetables?
I am sure the response will be the same one that we hear time and again: that the Government are investing £10 billion more in the NHS. We know, however, that that is an illusion. The Health Committee has confirmed that they are in fact delivering less than half of that, while at the same time chronically underfunding social care. The NHS has just had its biggest deficit in history under the stewardship of this Government, but the Secretary of State is not simply trying to convince us that he will maintain services at their current level, he is telling us that he will somehow do more.
The Government are in denial. It seems that virtually every day, somebody is warning us that the NHS is on the brink of collapse. Only this weekend, the chief executive of NHS Providers said that
“we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate”.
The Society for Acute Medicine has warned us that the NHS could experience “pockets of meltdown”. In the real world, not one serious commentator or senior NHS  manager—not one—believes the NHS can deliver the services that it currently does, function safely, improve quality, move to 24/7 working and be financially sustainable. Let us end this charade; let us open up the debate and get to the truth about the damage being caused to the NHS by this Government. I commend this motion to the House.

David Mowat: In the six minutes available to me, it will not be possible to respond to the 40 or so speeches that we have heard today. I shall just pick out two contributions for special mention. First, so far as I can see, the shadow Secretary of State genuinely believes that an organisation that provides care to 45 million people on a budget of £100 billion should not do planning. That really appears to be the view of the hon. Member for Hackney North and Stoke Newington (Ms Abbott). Secondly, the hon. Member for Central Ayrshire (Dr Whitford) made an excellent speech, in which she used the word “opportunity” in connection with STPs, which is what they provide. She also said usefully that healthcare systems were about “more than buildings.” As we go forward with this process, it is important that we all think about what that means.
The health service is not static. Technology is changing; drugs are changing; expectations are changing; and, as we have heard, demography is changing. It is right to try to make it evolve and help it to change. The STP process is the planning mechanism to do so. It is a planning mechanism to put in place a five-year view—this was in the manifesto—that NHS England has developed. If it is to work, it must have three things: it has to be care driven; it has to be properly funded; and it has to be locally driven. It is all those things.

Jamie Reed: rose—

David Mowat: I shall not take interventions; I now have only five minutes left.
When it comes to funding, we have put in an extra £10 billion, and it is real money. If that money had been available in Wales, some of the points raised in the debate about the interface between us and Wales would have been quite different. This year, the increase in health funding is 4% in real terms—three times the rate of inflation. The real point, however, is not to do with money—however much the Conservatives put in and however much Labour says it might put in, although we have not heard that yet. But however much is put in, it does not detract from the need for the health service to be managed effectively and properly so that it can improve and innovate.
There is a prize from these STPs. At the end of the process, we will have a health service that is more oriented towards primary and community care where people live. The health service will provide better access to GPs, emphasise prevention more than ad hoc responses, properly address long-term conditions such as diabetes and begin to address more quickly our mental health and dementia commitments. I say again that if STPs do not address those things, they will not go forward. Perhaps the most important of all the advantages is that  the unacceptable gap that currently exists between healthcare and social care will be breached. That is at the centre of the whole process.

Karin Smyth: Will the Minister give way?

David Mowat: No, I will not. I have only four minutes left, but the hon. Lady, who worked with me on the Public Accounts Committee, can come and see me.
It is also true to say that if we achieve all those things, there will be lower hospital admissions and more humane and timely discharges. That might save money, but it is not being driven by the need to save money. It is driven by care needs because that is the right thing to do.
Let me deal quickly with the STP process. We have been told that it is a secret process and a Trojan horse for privatisation, and we have heard that we are not going to consult. Well, let us talk about consultation first. The right hon. Member for North Norfolk (Norman Lamb) made some good points about the difficulties involved in change programmes on which proper consultation does not take place. However, we must have something on which to consult that is reasonably agreed and reasonably stable, because if we do not, we shall give rise to expectations that cannot necessarily be fulfilled—in both directions, positive and negative.
When the STPs come back in October after being signed off, they will be consulted on. A document that will be in the House of Commons Library by the end of the week will describe in detail how all the stakeholders will be consulted and what we will do, but in any event—this point was made by my right hon. Friend the Member for Chelmsford (Sir Simon Burns)—no consultation and no engagement will take away the statutory commitments, the need for configurations to be looked at properly, and the requirement for nothing to proceed that has not been locally agreed.
We were told that the plans were secret. In fact, they were so secret that they were announced in December 2015, in the NHS planning guidelines. They were so secret that 38 Degrees, which was responsible for the principal leak, obtained its information from the websites of the organisations that were keeping it all secret. If we ever do something in secret in future, it really will be done better than this.
The STP process is complex. It will not work equally well in all the locations, and there will be issues to resolve. Some plans, if they are not adequate, will not be proceeded with in the same way as others. I say this to Members, however: we need you to engage with the process—

Rosie Winterton: claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Main Question accordingly put.
The House divided:
Ayes 195, Noes 280.

Question accordingly negatived.

BUSINESS WITHOUT DEBATE

Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Constitutional Law

That the draft Human Trafficking and Exploitation (Scotland) Act 2015 (Consequential Provisions and Modifications) Order 2016, which was laid before this House on 11 July, be approved.—(David Mundell.)
Question agreed to.

Nottingham Express Transit Extension

Motion made, and Question proposed, That this House do now adjourn.—(Chris Heaton-Harris.)

Anna Soubry: I note the rush as everybody wants to join in this debate. They all seem to be leaving—what a surprise! I warmly welcome the Under-Secretary of State for Transport, my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who is sitting on the Front Bench—and rightly so. Who better than the hon. Member who represents Blackpool to deal with and respond to this debate about the extension of the tram system through my constituency and onwards to Toton.
I want to make it clear that this short debate is not about the rights and wrongs of trams or about funding. This debate is about looking at what happened as the tram works took over two years to be completed—an undoubted nightmare for residents and my business community. It is about learning lessons to ensure that we never get a repeat of an unfortunate and wholly unacceptable tale of woe over two years and eight months. I lived in Nottingham for about 25 years until I was elected in 2010 and I use the tram. It is a pleasant and modern form of public transport. I am not anti-tram, but I am anti the experiences of so many of my constituents.
The tram network cost £570 million. It was unfortunately eight months late. It has been a sorry tale. A photograph speaks a million words, so I have been asking people to look at my website and to follow the photographs that I have been tweeting because they really show what has been a nightmare for my constituents. We have to learn the lessons. We must also be aware that often when we undertake these huge pieces of infrastructure, many people feel that they have suffered incredible pain and have not actually gained much themselves.
I want to start with what is a big problem in our society. A huge swathe of our society feels that they have no voice post-referendum. They feel disconnected and unrepresented; in short, they feel powerless. A large number of my constituents in the affected area feel the same. I want to congratulate a Facebook page called the “NET Tram Extension Ranting Room”. It was created by one of my constituents, a man called Tony Smith. He will forgive me if I say that he was a completely ordinary person—in fact, he is a rather remarkable person. He set up the Facebook page in real frustration in the face of these tram works. As events have taken place, it has emerged that since about the 1990s people have, understandably, felt in favour of the tram. They want better transport—“We like it; it’s a good idea.” However, what we do not like is when people use aliases; they do things online and offline in their campaigning that create an atmosphere in which people feel, “I don’t agree with that, but I have no voice. I have no say. I can’t get involved in this. When I go to a public meeting, I am howled down.” People feel powerless, as happened in this case in the run-up to the public inquiry in about 2007.
I urge the Minister to examine public inquiries. I will write to him in more detail about how I feel we can ensure that ordinary people’s voices are genuinely heard. I am very concerned about some of these online questionnaires, which are very prescriptive, and about  the fact that people can organise in campaign groups and then abuse social media to make out that they have more supporters and followers than they have. In public inquiries, there is no genuine equality of arms. We were left dealing with this barrage of local authorities—the city council, the borough council and the county council—and the people who wanted to build the tram. They have the ability and the resources to employ experts, counsel and sometimes Queen’s counsel, although I make no complaint about any of these things. Often the campaign groups can do that, if they are well organised and have some money together, whereas an ordinary citizen often relies on their borough councillor. They are well meaning, good people, but they are nothing like as well prepared and do not have all the resources that others have. What has come out of the experience in my constituency is that ordinary people living on the very streets that were about to be dug up felt that they had no voice and no say. We must make sure that we have real equality of arms in public inquiries, so that everybody can be heard and everybody can be represented.
The “ranting room”, as it is now called, has almost 1,950 members. It is not always pretty, as the language is often fruity and I would completely dissociate myself from some of the comments. But this is a place where genuine, ordinary people have come together to protest as they saw their community being dug up. They felt completely disfranchised and saw their lives being turned over. Out of this has come much good: a community has been formed; there have been a few romances, and lots of friendships have been made.; and there has been a continuing desire to hold people to account and make sure that the lessons are learned.
What are those lessons? First, we must make sure there is proper consultation and that ordinary people feel that they have a voice and it is heard. We also must ensure that we plan properly for these huge pieces of infrastructure. We are looking towards some of the work that the Government have, quite properly embarked on, such as HS2. I am a great fan of HS2 and I stood on a clear platform of supporting it; the East Midlands Hub is coming to Toton, and that is extremely good news. I believe it is supported by the majority of people in my constituency. I believe the Minister has also had a project in his constituency, so he knows that these pieces of infrastructure must be done properly. Let us learn from these various experiences.
On proper planning, we must make clear the benefits that we seek to achieve. Obviously, if the tram system in Nottingham is extended into a place such as Toton—the hon. Member for Nottingham South (Lilian Greenwood) is here and I know that the other line went to Clifton—the fundamental benefit will be to provide good public transport, not only for all those people who live along the line but for commuters who use the park-and-rides at the terminuses. We know that we want to get cars off the road, to get people into the city more quickly and to reduce emissions—those are all laudable things. I have no difficulty with making sure that people can catch the tram and go to the Queen’s Medical Centre, the Central College in my constituency or Nottingham University. These are all good things.
We should be looking with more care at the business cases often attached to these projects, and ensuring that some of the big claims that are made are accurate. The 2011 business case said that 10,000 jobs would be  created by the extension of the Nottingham tram system. Indeed, it said that the town of Beeston, which sits in my constituency, would be regenerated and transformed.
Motion lapsed (Standing Order No. 9(3)).
Motion made, and Question proposed, That this House do now adjourn.—(Chris Heaton-Harris.)

Anna Soubry: I think that there may be some hollow laughter from people in Beeston, which is a great town and a wonderful place with great independent shops, cafés, bars and fabulous pubs, as they are yet to see this regeneration and transformation. This is a town that was effectively strangled by the works. The works were meant to last for two years; in fact, they went on for an extra eight months. Yes, we do have a shiny new tram, and Beeston High Road, where my constituency office sits, looks good. Unfortunately, it is bereft of shoppers, and the town centre needs urgent and radical improvement. All of those things could have been done when the town was being dug up, but, sadly, they were not, and that was a really big and serious failure.
If we are creating huge pieces of infrastructure, we must look at the full picture so that when the infrastructure is completed in these residential, urban and suburban areas, everything is there that we want—the place is sorted out and the new transport is in place. Then the town can recover from what has been an extraordinary and damaging experience for people.
I have been talking about businesses, but residents too have been affected. I am thinking of the residents on Lower Road and Fletcher Road, two lovely, quiet cul-de-sacs, who suddenly found a major infrastructure project and power drills literally by their front doors. They were affected not just for a few weeks, but month after month. Indeed, it became year after year, and they had to live through it all—the photographs really do say it all. The issues still go on, because now we have problems with the drains. It is as if everything has been dug up and started again.
In that planning, it is also very important that tiny things are considered. They may seem very minor, but they are in fact hugely important. I am talking about the small details, the stuff of life that really makes a difference to the quality of people’s lives. It makes a difference as to whether people feel engaged with something or totally alienated by it. Apparently, Sky News used to look at my email newsletter when I was raging on about these works and the inconvenience and upset that they were causing to my constituents. This may seem a small point, but it was incredibly important that my constituents could not get the fencing that they said they had been promised to screen the track. These were people who had enjoyed a green vista, either over the allotments or over a piece of green open space. The tram comes along, and they have all the disruption and then they find that they cannot get the right height of fence. I know it sounds small, but for people living on Brookland Drive, Lime Grove Avenue or Holkham Avenue, it meant an awful lot and we had to fight like tigers to get the right fence.
I pay tribute to the City Council in Nottingham, and, essentially, I understand what was happening. In effect, the tram benefits the citizens of Nottingham. It goes  through my constituency, and it does benefit those people who choose to use it, but the pain that it has caused has been extraordinary. We have a democratic gap in accountability. It is the people of Beeston and Chilwell who have suffered all this disruption, but the accountable authority was not their local council, but the city council. With great respect to John Collins, the leader of the city council and a man I like—he is not from the same political party but that does not matter; he would always meet me and try to help—this sounds harsh, but it was never in the city council’s interests to sort it all out, because its members were not going to take the hit at the ballot box when the next set of elections came along. We need to ensure that there is some better way of doing things, so that there is genuine accountability when things do not go right.
Construction was a nightmare. We need good, responsible and efficient construction and proper communications with people. One of the things that drove wonderful community champions—a lot of good came out of this for the community, including wonderful people such as Allison Dobbs, who suddenly stepped up and almost devoted her life to representing people—was this terrible lack of communication. People were literally being told, “Oh, by the way, in two days’ time you’re moving out of your home for a week or so because we’re going to work through the night.” Carole Wall stepped forward as well. I also have to mention Lloyd Wildish, a man who had lived on Lower Road all his life, but who was ignored when he talked about the state of what was under the roads—his local knowledge was ignored. Obviously, construction has to be done on time, but we have to make sure that the works are done in a reasonably civilised way so that people’s lives are not as blighted as they were when this huge piece of infrastructure was being built on their road.
I have a photograph of somebody on High Road. Her front room is almost on the pavement, and there is a man with an enormous drill leaning against a board that is leaning against her front window. That was the reality of life for people throughout the tram works. There must be a better way of doing things so that we take much more care about the lives of people living near these major pieces of infrastructure.
On working times, I accept that we have to crack a lot of eggs when we are doing these sorts of projects. Obviously, they can be hugely beneficial, but there must be better ways of organising things so that we reduce the dust, the noise and even the rats. As I say, it was a terrible experience for the residents, and, for many of them, it is one they will not forget. By way of example, we were told that High Road, which is where my constituency office is, would be closed in one direction for six months and then in the other direction for another six months. In the event, the whole road was closed for a year. Indeed, I brought my right hon. Friend the Member for Derbyshire Dales (Sir Patrick McLoughlin) to see, and I do not think he could believe it. I brought my right hon. Friend the Member for Tatton (Mr Osborne) down, and I do not think our former Chancellor could believe the scale of the works and the incredible adverse impact they were having on business and the lives of ordinary people. Again, when it comes to construction, there has to be better organisation. When we promise people, by way of example, that there will be good communication, we should make sure that we deliver.  Literally putting a leaflet through a letterbox the night before some huge disruption takes place is simply not acceptable.
Let me turn to compensation. Part of the public inquiry talked about how businesses would be compensated, and plans were put in place. In the event, the area in which businesses could claim was far too restrictive. Then, as the whole of High Road was closed down and businesses were on the brink, frankly, of going under, it took a campaign to get funds, but we did it: we had a petition, we went to the city, we went to the county council and we got extra funds for, effectively, an emergency hardship fund. Again, I pay credit to the officials at Broxtowe Borough Council, at the city and at the county who did everything they could to speed that up, but it took an awful lot of aggravation from their Member of Parliament to achieve that. It should not take that; it should not need me to have to fire off emails, and go to the press and so on to make sure that businesses are properly compensated and properly taken care of.
It could be argued that that compensation should continue as businesses try to make good the damage that has been caused to the town of Beeston. For two years, as I said, the town was in the stranglehold of these construction works. We all know how we shop; most of us are creatures of habit. Of course, what has happened is that a large number of people have simply gone elsewhere and formed new shopping habits. I do not mean any disrespect to Long Eaton in Derbyshire—it is a very nice place—but people have undoubtedly gone off to Long Eaton to go shopping. They have formed new shopping habits, and now we have to drag them back—well, I do not want to drag them back; I want to encourage them back—to their previous habit of shopping in Beeston, but that takes a lot of effort. Again, it needs proper planning, and we need to do that before the event, not while the nightmare is unfolding.
For residents, however, there was no compensation at all. There was no compensation for the dust, the noise and the piledrivers, day after day, month after month, with people walking on duckboards with their shopping, their car parked further down the road, slipping in the dark with no streetlights. There was no compensation for that loss of amenity and that destruction of the quality of life. I urge the Minister to look at this when we go on to other big pieces of infrastructure projects, to make sure that we do not just dismiss residents and think, “Oh, they’ll put up with it. We’re cracking these few eggs to create this glorious omelette, and when the tram”—or the road, or HS2, or whatever it is—“comes, they’ll see that it was all worth it.” I have to tell the House that many of my constituents do not believe it has been worth it, by any means—and it still goes on. This is such a small thing, but I really hope that as a result of this debate somebody could go and put in the flowerbed that was promised, cut the grass, as was promised, and make the entrance to the lovely cul-de-sac that has been ripped up on Lower Road, going on to Fletcher Road, look good. That would give the residents just something back after everything that they have been through.
I do not want to sound overly negative, but there are those—some of whom have not always covered themselves with much glory in the way they have campaigned in favour of a further extension of the tram—who now  seek to persuade the city council to extend the route up into Kimberley and onwards into Eastwood. I do not represent Eastwood, but I do represent Kimberley. The good people of Kimberley have looked at what has happened in Beeston and share my concern that they will find that the works will not be worth it. I certainly will not support any extension of the tram works to anywhere else until such time as we have learned the lessons.

Lilian Greenwood: The right hon. Lady rightly asks the Minister to look at the lessons that can be learned from this important infrastructure project, which created real hardship for many of my constituents—residents and businesses—as it did for hers. Does she agree, however, that Nottingham City Council is to be congratulated on creating a world-class public transport system, such that the Campaign for Better Transport has recognised Nottingham as the least car-dependent city? The tram is reducing congestion, not just for those who use it but for those who drive on our city’s roads, cutting carbon emissions, and tackling air quality, which must be an issue in her constituency as it is in the centre of Nottingham.

Anna Soubry: Nottingham is not alone in having a tram system. Many other great cities in our country have tram systems, and many of the lessons to be learned will apply to them too. There is nothing new in it.
I like the tram, but, my goodness, we are going to need to have more debates in this place about the cost of trams, and the fact that they have to connect with other types of transport. That is absolutely critical. It is a crying shame that cyclists have found that the tram tracks are dangerous. I do not think there is any doubt about that, but if there is, we will have another debate about it, and I look forward to that. We have to connect up transport. Another thing that has come out of this is that there are now parts of my constituency where people cannot use their bicycle because of the narrowness of the route. This also applies to HS2. It is critical that we get the routes right so that we do not have a situation where a tram track, as in my constituency, is winding around when there was no doubt a better route that would have far better delivered people along the transport system and reduced the amount of disruption.
As I say, there are lessons to be learned. I look forward to my hon. Friend the Minister coming to Beeston, seeing the tram system, and speaking to my brilliant constituents. I know that he will take up these lessons and, I hope, apply them to all infrastructure projects as they go forward.

Paul Maynard: It was a pleasure to listen to the speech by my right hon. Friend the Member for Broxtowe (Anna Soubry), who spoke with her customary vim and vigour. It is fair to say that she and I share a great deal of experience of major tram works in our constituencies. They are not always plain sailing, particularly when they happen to cross the borough boundary of the sponsoring authority. That can cause problems and I recognise in what she has said a lot of my own past seven years as a Member of Parliament.
The Government are supportive of light rail in the right place. It is clear that it is a mode of transport that is convenient, reliable and increasingly popular. It also has considerable scope for innovation, particularly where it offers an alternative to expensive heavy rail solutions to potential transport problems. More people are travelling by tram and light rail than at any time since records began in 1983, with a 5.8% increase in the past year alone. The improvements being made to services are creating not just transport systems that people can rely on, but jobs, growth and opportunity—and the fly that seems to have taken an overly close interest in my head as I speak—as part of building an economy that works for everybody.
Recent analysis of six light rail networks by Transport Focus shows that overall journey satisfaction increased to 92% in 2015, and the figure is an incredible 98% in Nottingham. Those are the types of satisfaction figures that every politician dreams of—if we could but get them. That is why the Government have committed £371 million to the overall phase 2 of the Nottingham tram system.
I am sure that my right hon. Friend does not need me to highlight the importance of Greater Nottingham’s economy, which is worth approximately £10.7 billion and supports about 300,000 locally based jobs. Nottingham is a regional capital and an important industrial and commercial centre. It is vital that it has a transport system that is reliable and can support customers, shoppers, commuters and visitors.
The light rail system is a key element in Greater Nottingham’s transport strategy. Since phase 1 opened, it has served more than 10 million passengers a year, taking approximately 3 million car journeys off the local roads and improving accessibility for local communities. Phase 2 has been open for just over a year, and it is already clear that it is boosting the local economy and improving employment levels and supply chain expenditure in the local area.
There are an immense number of positives that I could list at great length in the time available, but I acknowledge my right hon. Friend’s point that it has not all been plain sailing. Work on the extension presented a number of challenges, which affected the local community. Closing two main roads for six months for safety reasons had an immense impact on local communities, affecting trade for local businesses. During the Blackpool upgrade the centre of Cleveleys was cut off for a while and many of the businesses on Lord Street in the neighbouring town of Fleetwood also had to shut down, so I have seen for myself the impact that can have on a local community.
Although it is inevitable that any such project is going to cause disruption to third parties, including local residents and businesses, that needs to be properly and effectively managed and planned, in co-operation with the local community. I know that efforts were made by the promoters to help minimise the impact, but it is always clear that more can be done. I know that the promoters undertook a number of additional measures to help deal with the problems encountered along the way, including a discretionary financial package for small businesses and logistic support for traders and visitors during the particularly intrusive works. I suspect that my right hon. Friend herself had a significant hand  in the development of much of that. I think that such measures need to be put in place much earlier in the development of such schemes, so that businesses and residents have greater certainty about what help will come their way.
I know that there were particular concerns about communication with stakeholders and local people, and I agree entirely that engagement with businesses and residents must be undertaken, both at the time of the scheme’s original development and throughout its construction, and in a timely fashion so that no one is taken unawares.
I am convinced that more can always be done in such situations. Uncertainty about both the timescale and the timeliness of works can harm small businesses and the decisions that people make about how they spend their lives, where they live and what they do with their properties. With that in mind, I wholeheartedly agree with my right hon. Friend that it is vital that lessons are learned in the construction of all major local infrastructure projects. I understand that, in this particular case, a lessons learned report is due to be published shortly. It will have to focus on issues such as project programming; delivery planning; how utility diversions can be managed better; the nature and extent of disruption to third parties; and the implementation of traffic management measures.
Both the Department and I will want to study the outcomes and conclusions of that report as we consider what further steps are required. I agree that we need to apply these lessons to future infrastructure projects to do all we can to minimise negative impacts, and we will work with UK Tram which represents the wider light rail sector to disseminate these findings.
I will be delighted to come to Beeston when we can fit a visit into our diaries and I look forward to meeting my right hon. Friend’s constituents. I take note of her points about cycling safety. I have seen for myself in Blackpool that what appears to be a cycle path can be all too inviting, when in fact it is not a cycle path at all—it is a tram track, and cycles have no place on tram tracks. I entirely support the points that she makes on that.

Chris Leslie: I commend the right hon. Member for Broxtowe for raising important points about taking care during infrastructure construction, but my constituents use the tram, they love it and they would like it to extend eventually to the east side of the city.

Paul Maynard: I note the hon. Gentleman’s comments. I hope I have made it clear that I think there are immense benefits from light rail, both in Nottingham and around the country, but those positive aspects should not minimise the impact on those who live immediately adjacent to the tram tracks, who may encounter disruption. In my constituency the tram track has been there for 100 years, so when it was upgraded the disruption was no surprise to anyone. When we are planning new tram routes, that may come as more of a surprise to people, who were not expecting the route to appear on a particular road. It will always be a case, I suppose, of horses for courses.

Anna Soubry: Does my hon. Friend agree that we might have an interesting debate in this place about the safety of tram tracks and bicycles? There are many  examples in Sheffield and Edinburgh, I believe, and not just in Nottingham, of people who have suffered. I have a constituent who nearly died as a result of their wheels getting stuck in tram tracks. Does my hon. Friend share my concern? I can assure him that in a large part of the scheme in Nottingham, including in my constituency, the tram track and cycle routes are coterminous.

Paul Maynard: My right hon. Friend tempts me into what risks becoming a specialist subject of mine—the safety of the tram tracks in my own constituency. Whenever the road and the tram occupy the same space, it can be very difficult, particularly for visitors who are not familiar with the road layout. For Blackpool, being a tourist town, that is a particular concern. People do not realise that the tram track is in fact the tram track. I will be delighted to have that debate at some point. My frustration might be that I have to be the replying Minister, who therefore cannot take part in it.
I noted my right hon. Friend’s important points about the public inquiry system. The process has to be collaborative from the beginning. As she noted, the project had to follow proper planning approval processes prior to construction, leading to a public inquiry. These inquiries are overseen by an independent inspector and the process allows both supporters and objectors to raise concerns, including consideration of the route alignment, whether alternative modes could be considered, and the anticipated transport, regeneration, environmental and socio-economic impact and benefits of such a scheme. As she knows, just such a public inquiry was held for Nottingham express transit phase 2, which would have considered views of all parties. However, I genuinely hear the points that she makes about the need for a balanced approach to ensure that everybody who  has an interest gets a fair chance to have their say, and that those contributions are considered in the round, rather than it being a case of he who shouts loudest. I look forward to hearing her views when she writes to me and we will look closely at them.
I note why the issue is important, with HS2 potentially coming to Toton. I know that the Secretary of State is yet to make an official decision, but I gather that no alternative location is currently being considered. That may well mean a serious application to extend the tramway to Toton, which would raise all these concerns yet again. We have to learn from what we did the first time around and ensure that, if the tramway is extended, those mistakes are not made again.
In conclusion, we will continue to work with the light rail and tram sector to help to bring down costs, but the decision over which schemes to develop will continue to rest with local areas. That said, it is vital that lessons are learned about minimising disruption with all sorts of infrastructure projects, allowing more communities around the country a say in how light rail—or, indeed, other solutions—is developed to benefit their communities.
I am a Minister with responsibility for light rail who is not unacquainted with trams. Light rail as a whole will have an important role to play, but it has to happen with communities and not simply to them. That will be my watchword as we move forward. I hope that we will see the growth of light rail across the country where it is most appropriate, working with the communities who will be affected, not against them.
Question put and agreed to.
House adjourned.